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Balance Clinical Counselling
Shelley Garneau, MNLP, MC, RCC
Registered Clinical Counsellor (Registration # 11881)
(Located at Thrive Therapeutics) 850G 12th Ave. Campbell River, BC V9W 6B5
778-346-3446
Informed Consent
Welcome to my private practice. This document contains important information about my
professional services and business policies. Although these documents are long and
sometimes complex, it is very important that you understand them. When you sign this
document, it will also represent an agreement between us. We can discuss any questions
you have when you sign them or at any time in the future.
Counselling is a relationship between people that works in part because of the clearly
defined rights and responsibilities held by each person. As a client in counselling, you
have certain rights and responsibilities that are important for you to understand. There are
also legal limitations to those rights that you should be aware of. I, as your counsellor,
have corresponding responsibilities to you. These rights and responsibilities are described
in the following sections.
Goals of Counselling
There can be many goals for the counselling relationship. Some of these will be long term
goals such as improving the quality of your life or learning to live with mindfulness and
self-actualization. Other goals may be more immediate such as decreasing anxiety and
depression symptoms, developing healthy relationships, changing behavior or
decreasing/ending substance abuse. Whatever your goals are for counselling, they will be
set by you according to what you want to work on in counselling. The counsellor may
make suggestions on how to reach that goal but you decide where you want to go.
Risks/Benefits of Counselling
Counselling is an intensely personal process which can bring unpleasant memories or
emotions to the surface. There are no guarantees that counselling will work for you.
Clients can sometimes make improvements only to return to past behaviors or patterns
after a period of time. Progress may happen slowly. Counselling requires you to be an
active participant where you put effort into the process and work at applying the skills
learned into your daily life. In order to be most successful, you will have to work on
things we discuss in therapy outside of sessions in your real life.
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However, there are many benefits to counselling. Counselling can help you to develop
healthy coping skills for dealing with the many challenges we face in life, make
behavioral changes, reduce symptoms of mental health disorders, improve the quality of
your life, learn to manage difficult thoughts and emotions, learn to live in the present
moment and many other advantages.
Confidentiality
Your counsellor will make every effort to keep your personal information private. If you
wish to have your information released, you will be required to sign a consent form
before such information will be released.
Your counsellor may consult with another professional counsellor in order to receive
appropriate supervision and in order to provide you with the best service. In the event
your counsellor consults with another professional counsellor, no identifying information
such as your name would be released.
There are some limitations you need to be aware of. Counsellors are required by law to
release information for the following situations:
1. When a client poses a risk to themselves or others (i.e., suicidal or homicidal
behavior) steps are taken to address safety issues
2. Disclosure of abuse or neglect to children or the elderly would need to be
reported
3. If your counsellor receives a court order or subpoena, she may be required to
release information. In such cases, your counsellor will consult with other
professionals and limit the release to only what is necessary by law
Appointments
Appointments will be 60 minutes in duration, dispersed at a timeframe we agree upon,
although some sessions may be more or less frequent as needed. The time scheduled for
your appointment is assigned to you and you alone. If you need to cancel or reschedule a
session, I ask that you provide me with 24 hours notice. If you miss a session without
canceling, or cancel with less than 24 hours notice, you may be required to pay for the
session [unless we both agree that you were unable to attend due to circumstances beyond
your control].
It is important to note that insurance companies/benefit providers do not grant
reimbursement for canceled sessions; thus, you will be responsible for the cancelation
fee. In addition you are responsible for coming to your session on time; if you are late,
your appointment will still need to end on time.
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Professional Fees
You are responsible for paying at the end of your session unless prior arrangements have
been made. Payment may be in the form of cash, debit, VISA or MASTERCARD. If you
refuse to pay your debt, I reserve the right to use an attorney or collection agency to
secure payment. Fees are non-negotiable. Fees are subject to change at counsellor’s
discretion.
If you anticipate becoming involved in a court case, I recommend that we discuss this
fully before you waive your right to confidentiality. If your case requires my
participation, you will be expected to pay for the professional time required.
Fee Schedule
Individual clinical counselling for 60 minutes - $110.00
Couples counselling for 60 minutes - $120.00
Contacting the Clinical Counsellor
I am often not immediately available by telephone. I do not answer my phone when I am
with clients or otherwise unavailable. At these times, you may leave a message at
778-346-3446 for non-urgent matters, like canceling or rescheduling your appointment.
Your call will be returned as soon as possible. It may take a day or two before I am able
to get back to you.
If you feel you cannot wait for a return call or if it is an emergency situation then the
following options are available to you:
1. Go to your local hospital
2. Call 911
3. For immediate emotional support you can call the 24hour Vancouver Island Crisis
Line 1-888-494-3888
4. For emotional crisis situations you can access the crisis nurses at the Campbell
River General Hospital at 250-850-2647. Crisis nurses are available 7 days per
week from 9:30 am to 9:30 pm
Consent to Counselling
Your signature below indicates that you have read this Agreement and agree to its terms.
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Client Signature
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Date
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Shelley Garneau, MNLP, MC, RCC
Registered Clinical Counsellor
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Date