INFORMED CONSENT

Thank you for choosing our services. We would just like to take this moment to share with you how things work at Family TLC.

If you need to contact us, please feel free to leave a message at any time on our confidential voice mail at (705) 737-3513. We will only be responding during business hours. IF THERE IS AN EMERGENCY, PLEASE CONTACT ONE OF THESE 24-HOUR CRISIS SERVICES – THE MENTAL HEALTH CRISIS LINE AT 728-5044 OR TELECARE BARRIE AT 726-7922. IF IMMEDIATE EMERGENCY SERVICES ARE NEEDED, PLEASE DIAL 911.

Our services are confidential and no one at Family TLC is permitted to release your name, information about you, or details about your counselling to anyone outside of Family TLC’s office without your informed, voluntary and written consent except as may be required except as outlined by law and as further described under the Terms of Services and Privacy Policy linked below. We highlight here that this confidentiality is subject to specific exceptions in situations related to:

1. a client’s intention to imminently to end their life or to cause harm others;
2. a member of a vulnerable sector suspected of being at risk or abused;
3. a court order to release a client’s file; as well as
4. the reporting of a professional who has sexually abused a client.

We encourage you to regularly review the Terms of Service and Privacy Policy which you accepted when completing the informed consent form.

Now that you have booked your first appointment, we agree to provide our services to you as a Family TLC client. As described during the intake process, you were matched with a therapist who works with a number of Family TLC clients seeking services such as yourself. All Family TLC clients have the benefit of a team approach which includes the therapists they are directly working with and the supervisory team lead by Sue Cook.

All professionals who work with Family TLC clients have signed a confidentiality agreement and meet weekly for clinical support. The therapist that you are seeing may bring your case up for discussion anonymously.

In the interest of protecting all Family TLC clients and to sedulously guard the unique privileges exchanged between patient and counsellor as part of the counselling relationship, at no point will any session notes, documents, recordings, records or any other kind of material created within the counselling service be voluntarily released for litigation purposes. By continuing with our services, you agree to refrain from causing, directly or indirectly, a summons or subpoena requiring any Family TLC member (including but not limited to, any agents, employees, directors, or any of their successors or assigns, person(s) who conducted the initial intake, provided counselling, coaching and/or mediation), or any documents produced or prepared as part of Family TLC services, to appear before a judge, arbitrator, or tribunal in proceedings against any person, whether or not a family member, spouse or partner. You also agree that you will not disclose any information obtained from Family TLC on behalf of any person for whom you are consenting to receive services from Family TLC, such as a minor. In the event that a member of the Family TLC team is required to attend under a court process or order, you will be responsible to pay the Family TLC team member their hourly rate for preparation time, time spent at court, whether or not testifying, as well as the time required to report and record their attendance, as well as any lawyer’s costs, disbursements and expenses incurred by any Family TLC member, where applicable.

Each standard counselling session has a set fee. Payment will be collected at the beginning of your appointment with cash, cheque, credit card or debit. Our cancellation policy is simple: we ask that you provide us with at least 2 business days’ notice if you need to cancel or reschedule an appointment to avoid a cancellation fee. With insufficient notice the session fee does apply.

Please Note: the average session is 50 minutes in length however, with special request, the time may be extended if scheduling permits and you will be billed accordingly.

Adherence to the following principals will foster a strong relationship between you and Family TLC:

• Maintaining a mutually respectful session between yourself and your therapist(s);
• Seeking to understand of the importance of counselling and therapy;
• Undertaking to apply the learning developed through therapy; and
• Reviewing the scope of your own benefit coverage programs;

At Family TLC, we believe in creating a safe and respectful environment for our clients. We ask clients to do the same for our therapists as well. Family TLC does not tolerate the following: verbal harassment, threats, destruction to property, violence, or any other behaviour that would cause harm to our therapists. If a client does cause harm to a therapist of Family TLC, then we will discontinue our service to the client and press any financial or legal charges when appropriate.

BILLABLE SERVICES

Family TLC is entitled to modify, improve or discontinue any of its services including changes to the rates charged for such services. If the change in service pertains to you, Family TLC will contact you about the change. After Family TLC performs any of its services, there is no refund available for such services.

There are additional fees for ancillary items to counselling including, but not limited to:

• Invoice Re-prints –$5.00 each
• Photocopies –$1.00 per page
• Year End Statements –$10.00 each
• Administration Letter (which does not require Therapist) –$20.00
  (letter consists of confirmation of appointments and treatment plans. Payment must be received prior to preparation.)
• Letters or Reports by Therapist – will incur the same hourly rate as a face to face session (estimates may be communicated to clients, pre-approved with payment received prior to preparation)
• Letters – consist of any communication in writing to a client or third party are requested and includes an in-depth overview of case history; treatment goals and recommendations will be charged at the same hourly rate as therapy sessions.
• 15 Minute Therapy session or consultation – Pro-rated based on Therapists hourly rate
• Travel Time – 58 cents +HST will be charged per kilometre for any home visits or any other purpose that Therapist needs to travel

At Family TLC we will send the invoice to the payor of services. If you require a different arrangement for third party billing, please let us know so we can ensure all invoices are appropriately prepared.

Health Benefits

Some of our clients may be able to use their benefits to pay for the services of Family TLC. If you wish to do so, it is your responsibility to know what your benefits cover. For example, if your benefits cover therapy received from a psychologist, but you receive the service under a registered social worker, you may have to pay out of pocket. You will be able to switch to a psychologist afterwards, but the previous sessions will not be able to be converted and those costs will remain covered by you.

Family TLC is not responsible to interpret your benefits, and so we ask that our clients thoroughly understand their own benefit programs.

GUIDELINES FOR CLIENTS

Website, Mobile Application and Social Media Information

Where we make available content on our website, social media pages or mobile application, it is provided only as educational and informational in nature and not as therapeutic or clinical advice nor as replacement for professional, medical, therapeutic or clinical services. The information is not tailored to your specific circumstances.

You agree that Family TLC will not be responsible for any liability whatsoever resulting from other third parties that may be directly or indirectly related to our website, mobile app or social media pages, including but not limited to: books, comments, links to other websites, and all information and interactions of the linked websites.

Use of Email

At Family TLC, we may communicate with our clients via email. We respect your privacy and will not share or sell your personal email address with anyone else. By opting in to email communication, you agree to give Family TLC permission to communicate with you via email regarding appointments, customized care plan, bookkeeping and any letters or reports you request. You understand that email is not guaranteed to be private. See our Terms of Service and Privacy Policy for further information about our mutual use of email.

In order to respect the boundaries of professionalism and privacy that we share with our clients, Family TLC will not communicate with its clients through social media platforms or text messages. If you need to contact Family TLC regarding your appointment, please call our phone number or send us an email. If you have a crisis, need suicide prevention or deem yourself or others to be in danger of any kind, call 911.

Counselling/Therapy Responsibility

Family TLC does its best to serve its clients and is under the regulation of the professional colleges and regulatory bodies and their ethical policies and guidelines. We determine who are our clients and the purpose of counselling for each client. We collaborate with the client to establish counselling goals and use our professional discretion to determine the appropriate counselling/therapy modalities. We do our best to provide you with the tools you need for your situation. The success of counselling is in your hands; it is your application of the therapist’s advice that will help you.