Getting in Touch & Client Consent Response Form


In order to assist you with booking an appointment or to attend to your inquiries you are welcome to forward a confidential email and your request for information will be returned within 24 hours. 

Shoreline Therapy Group
E  shorelinetherapygroup@gmail.com

 


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Client-Counsellor Consent To Telephone/Online Treatment Form

All individuals who wish to engage in telephone and/or online counselling sessions are required to review Our Client-Counsellor Consent form and agree to the following conditions. By filling out and returning the form, you indicate that you understand and agree to the terms and conditions stated below:

  • You understand that your counselor practices in the province of British Columbia, Canada and is governed by the laws of this province.
  • Shoreline is not equipped for crisis or emergency situation and will not provide emergency care services of any kind.
  • You agree to supply your true full name, address, and phone number and e-mail address and that all of the information you provide is accurate, and that no important information has been deliberately omitted. You understand that if any of this information is inaccurate, this may be a limitation in our ability to help you.
  • Shoreline counsellors/therapists reserve the right to choose whether or not to work with you via phone. If, during our work together, your counsellor discovers that you are not, in fact, someone who can benefit from phone therapy, your counsellor will discuss this with you immediately and will suggest that you seek out the services of a therapist in an office in your local area.
  • If you are currently taking medication for depression, anxiety, or any psychological or psychiatric problem, your counsellor may ask for your permission to contact your physicians.
  • Phone counseling is not the same as face-to-face psychotherapy. There will never be a diagnosis over the phone. Therefore, if, at any point a diagnostic assessment is required you may be required to have a local face-to-face diagnostic assessment.
  • Shoreline cannot be held responsible for phone services that are temporarily out of service.
  • Confidentiality In General: As counselors in BC we protect the confidentiality of the communications and contacts with all clients, including phone clients. Your counsellor will only release information with your written permission, or if they are required to do so by a court order or legal subpoena.

  • Confidentiality Exceptions: According to BC law there are three situations where your counsellor is required to break the confidentiality that we work so hard to retain and call local law enforcement or social authorities.

  • If during your sessions you give any information that would lead your counsellor to believe that you may hurt yourself, someone else, or someone may hurt you in any way, your counsellor will notify the appropriate authorities to prevent such actions from taking place.

  • If during your sessions you give any information that would lead your counsellor to believe that there is neglect or abuse of a minor, your counsellor will notify the appropriate authorities to prevent such actions from taking place.

  • If during your sessions you give any information that would lead your counsellor to believe that a regulated health professional has been involved with sexual abuse, your counsellor will notify the appropriate authorities to prevent such actions from taking place.

  • Phone Confidentiality: Your counsellor will do everything possible to protect your identity and keep all confidences. However it is at times not possible to guarantee 100% protection of the confidentiality of phone calls if you choose to use a cordless or cell phone during a phone session. At times it is possible for someone with a scanner to possibly hear the conversation. The goal of phone counselling is to help you. If at any time, either you or your counsellor feels that working together is not helpful enough to you, either is free to terminate the relationship.

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By reading the above Shoreline Consent Form and submitting this response form, you are stating you understand and agree to the terms and conditions set therein.