Confidentiality Agreement

An important way of insuring confidentiality is to provide you with detailed information regarding our policy on confidentiality and understanding the nature of communications between you and a psychologist/coach.

To ensure confidentiality, all sessions are held using VSee, a secure online telehealth platform. VSee video chat is HIPAA compliant and provides data privacy in that all audio/video communication is securely encrypted and transmitted from point-to-point such that even VSee does not have access to any identifiable health information that may be communicated.

All inquiries and counselling sessions are considered private and confidential. No information of any kind is given to anyone without your signed consent, except in any of the situations listed below:

  • serious immediate threat to your life or welfare
  • serious immediate threat to the life or welfare of another person
  • suspicion of child abuse (children under the age of 16) or abuse of an adult        deemed dependent on another adult due to disability
  • report of imminent danger to the community at large
  • court subpoenas

There may be times when we may need to contact you or respond to you via post, telephone or online communications, unless you have instructed us otherwise. It is important, however, for you to realize there is the potential that these messages could inadvertently be received or overheard by an unintended third party.

Your psychologist/coach will work with you to establish goals and to define desired outcomes, as well as to clarify the purpose of any specific procedure or intervention.  We will make every effort to answer any questions on confidentiality or on any other aspect of the counselling/coaching process.

CLIENT NAME: __________________________  

 

SIGNATURE:  __________________________

DATE:              __________________________  

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