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Information and Consent Form

Consent for Treatment will begin with an intake/ assessment interview. This interview usually takes one to two sessions, depending on the presenting issues. Feedback regarding recommendations for counseling (i.e. therapeutic approach, length of treatment) will be provided, and goals for therapy will be decided upon together. When necessary, referrals to other professionals may be made (with your consent). You will be made aware of any changes to your treatment plan if changes are warranted. Psychotherapy may stir or trigger unpleasant feelings, and I encourage you to let me know if this is the case. If you have any concerns about treatment, I would encourage you to bring them to my attention first so that we may discuss the matter. Our sessions and the information you share with me are confidential. I will require your written permission to share information regarding your treatment and/or your attendance for treatment. However, by law, there are some instances which permit me to disclose confidential information. Those instances are as follows:

 -If you appear to be in imminent danger of doing serious harm to yourself or another person, I am legally mandated to intervene (i.e. call an emergency contact or family member, contact the police and/or the potential victim)

- If I have a reasonable suspicion based on your report, that you or any other child has been the victim of physical, sexual, and/or emotional abuse or neglect (by you or any other person), the appropriate Children’s Aid Society will be informed

- If there is a court order or summons presented for my attendance in court and/or release of your records

- If you reveal that you have been abused by another health care practitioner, I am legally obligated to report this activity to that practitioner’s regulating body

- If the need arises for me to contact a relative, friend, or potential substitute decision-maker. This would be required if you are injured, ill, or incapacitated and unable to provide consent personally. When necessary, I may seek supervision regarding your case. If this is required, I will not reveal any identifying information or any details that may allow my supervisor to know your identity.

Emergency Situations

If you are experiencing an emotional crisis that requires immediate attention, you may call my office to see if an emergency appointment is available. If I am not available, or if you are calling outside of regular office hours, please do one of the following:

- contact your family physician

- report to the nearest Emergency Room

Cost of Services

Individual therapy sessions are typically 55 minutes in length, with 5 minutes allocated to administrative tasks. The frequency of therapy can be discussed and agreed upon in initial sessions. Therapy may be able to be claimed as a professional expense depending on your employment contract. My services are not covered by OHIP. Acceptable methods of payment include cash, e-transfer, PayPal. Payment for treatment is accepted at each session. Receipts will be issued once payment is received. Please retain these receipts for your insurance and income tax claims, if applicable. I appreciate 24 hours notice if you are unable to keep your appointment time.

Electronic Communication/ Social Media/ Online Policy Email

It is my preference to use email or phone for initial inquiries and arranging or modifying appointments. Please do not email me any content related to your treatment, as email is not completely secure or confidential. If you choose to communicate through email, please be aware that all email communication will be retained in your treatment file.

Text Messaging: I prefer not to use text messaging to communicate with my clients, as text messages are not considered secure or confidential

 Facebook and other social networking sites: It is my policy not to accept friend requests or contact requests on social networking sites from any current or past clients. I believe that adding clients on social networking sites may compromise your privacy.


In an energy healing session, clients may remain fully clothed and, if comfortable, will lay on their backs on a treatment table. Occasionally clients may be asked to lay on their stomach. Clients are not expected to do anything during a session except to clear their mind, relax and enjoy. Depending on the type of session being performed, the therapist may lay the hands gently on different areas of the body, or they may simply hover above the body. Clients may have various experiences, ranging from the feeling of warmth and tingling throughout the body, a sensation of either floating or becoming very light, or the sensation of becoming very heavy and melding into the treatment table. It is common for clients to have an emotional release such as crying or giggling. Experiences will differ with every client. Following an energy healing session, clients are encouraged to remain as relaxed as possible. Sleep patterns may change, leaving the client either sleepy or energized. Please be sure to ask me if you have any questions regarding the treatment or post-treatment experiences.

It is essential to understand that no energy healing therapy can be accepted as a replacement for any prescribed or necessary medical treatment, but is best used as a complementary treatment.

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