Informed Consent for Counselling at BQWCHC
Welcome! We would like to provide you with some information about the counselling services we offer
at the BQWCHC. We are happy to spend as much time as you need reviewing this information. Please let
us know if you have any questions.
About Counselling
Counselling is different from talking to a family member or friend. Counselling involves having specific
goals that you will discuss with your counsellor. All counselling at BQWCHC is voluntary. We encourage
you to be open to techniques or recommendations your counsellor may suggest. We also encourage you
to be open and honest with your counsellor and to bring forward any questions or concerns you may
have throughout the counselling process.
The Counsellors at BQWCHC are Registered Social Workers through the Ontario College of Social
Workers and Social Service Workers. The College regulates their professional conduct which means they
cannot provide counselling to their own family or friends and must maintain professional boundaries.
Social Workers are also required to practice using evidence-based, best practice standards.
At BQWCHC, counselling is generally offered on a short-term basis and the sessions are goal-directed.
We generally expect that after the initial assessment or ‘get to know you’ appointment, you and your
Social Worker will jointly come up with specific counselling goals and a plan of service that will include
the goals to be focused on, number of sessions and how frequently you will meet. Generally, the length
of counselling services at BQWCHC is up to 8 sessions. This plan may change or shift as we review it
together throughout your counselling journey. Appointments are 45 minutes in length. We may also
recommend groups run at BQWCHC or in the community that fit your needs.
We ask that you please attend your scheduled appointments and call if you can’t attend. If you are late,
your appointment will still end at the originally scheduled time. Missing two or more appointments
without notice may result in your counselling file being closed.
Confidentiality
All of our services are confidential. We cannot disclose any of your personal information without your
implicit consent. For those who are registered with a doctor or nurse practitioner at BQWCHC, you
should know that information from your counselling sessions will be shared with other members of your
team to provide you with the best care possible.
There are exceptions to confidentiality where your counsellor has a legal duty to take action, which are
outlined in the general consent for services at BQWCHC that you sign upon registration with our centre.
Your counsellor will do their best to notify you if one of these situations occurs:
1. If your counsellor becomes aware of abuse or neglect of a child under 16 years old.
2. If you disclose imminent thoughts of harm to yourself or someone else.
3. If your counsellor’s clinical notes get subpoenaed by a court.
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4. If you disclose abuse by a health care provider.
Risks and Benefits of Counselling
Your counsellor may discuss sensitive material with you, which may result in you having unexpected
emotions such as feeling upset, annoyed, tired or angry following a session. Although this may affect
you in the short-term, the hope is that the long-term outcome will be positive. Our goal is to help you
improve your quality of life by assisting you in being actively involved in your own wellness.
Client’s rights
Our counselling services are voluntary. This form is asking for your informed consent to participate in
counselling. Once you have consented, we encourage you to actively participate in the ongoing
counselling plans. You have the right to refuse any recommended services and to terminate counselling
whenever you wish. We are required to document our counselling visits in your clinical record at the
Centre. You have the right to access your clinical records and your counsellor can assist you in activating
this process.
Client Consent to Counselling
I have had sufficient time to consider the above information and have asked any necessary questions.
I understand my rights, the limits to confidentiality and the nature of counselling including risks and
benefits.
I understand that counselling is voluntary and that I may terminate counselling at any time.
I agree to attend appointments to the best of my ability, talk openly and honestly with my counsellor
and provide my counsellor with feedback about how I think the counselling is working.
I agree to participate in ____ counselling sessions at the BQWCHC.
_____________________________
Printed Name
_______________________________
Signature
_____________________________
Date (dd/mm/yyyy)
Social Worker: I have discussed the above information with the client. To the best of my knowledge
the client understands this information and is able to provide informed consent to counselling.
______________________________
Printed name of counsellor
________________________________
Signature
_____________________________
Date (dd/mm/yyyy)
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