Required Form

Each person attending a counselling appointment must review and complete two required forms; the two have been formatted into a single document, entitled Required Form.  After downloading the file and printing the document, please review and respond to its content, sometime prior to your initial appointment, and bring the completed forms with you when attending your first session. There is no need to submit the forms in advance of your arrival.

Download the Required Form.

Important:   If you have questions, concerns, or confusion about any of the content composing the Required Form -- particularly the information addressed within the 3-page Informed Consent -- please do not sign the form.  Instead, allow me to address your question or concern when we meet, and offer your consent, by providing your signature, only after you have received an explanation that satisfactorily resolves your question/concern.

Authorization to Release Confidential Information

This form is to be completed only when you, my client, want me (a) to provide information about your participation in counselling/psychotherapy with me (either verbally, in writing, or photocopied from your file) to a identified third party; or (b) to receive information pertaining to you, my client, from an identified third party (either verbally, in writing, or photocopied from his/her records).

Use this form to specify the name of the third party with whom you want me to exchange information, the specific information you are releasing me (or the other party) to provide, and the specific reason for the requested exchange of information. These details limit your authorization to the named party you are releasing to provide only the information you have specified, for only the reason(s) you have indicated, to only that party you have named as recipient of the information. A signed Authorization to Release Confidential Information remains in effect for two years from the date of authorization, unless an alternate expiry date is provided.

Download the Authorization to Release Confidential Information form.

Consent to the Treatment of a Minor Child

This form is to be filled out only when counselling services are being sought for an individual under the age of 18 (i.e., a minor). This document provides consent for the minor to receive counselling and, therefore, must be completed by a parent, or legal guardian, of the minor.

Please note that the Required Form must also be completed (preferably by the individual who will participate in counselling), in addition to the requisite Consent.

Download the Consent to the Treatment of a Minor Child form.

Download the Required Form.