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Helpful Forms

If you are a new client, please complete the following forms and bring them to your first counselling session.

If you would like me to coordinate care with another provider (ie, family doctor, counsellor, psychiatrist), please complete this form:

Authorization to Disclose Form

Confidentiality & Consent Form

Intake Form

Insurance

Insurance Services may be covered in full or in part by your health insurance or employee benefit plan. You can call your Human Resources department and ask for the phone number for your Employee and Family Assistance Program (EFAP). You do not need to give any personal information to your employer, but information will be received and held in confidence by your EFAP provider. If you do not have EFAP coverage your extended benefits insurance might cover full or partial counselling fees. Please check your coverage carefully by asking the following questions:

  • Do I have insurance benefits for counselling?

  • Do you cover Canadian Certified Counsellors?

  • How many sessions or dollar amount per year, does my health insurance cover?

  • What is the coverage amount per therapy session?

  • Is approval required from my primary care physician?

Have questions? Contact me for more information. 

Confidentiality & Privacy Policy

Your privacy is of the utmost importance. As a Canadian Certified Counsellor (CCC#: 9838) with the Canadian Counselling and Psychotherapy Association (CCPA), I am bound to and follow the ethical practice of confidentiality. All communication and contact is strictly confidential and cannot be released without your written consent. Exceptions prescribed by provincial laws and professional codes of ethics, include:

• If a client discloses that they are likely to harm themselves or threatening harm of someone else, it must be reported and appropriate preventive action will be taken.

• If a client discloses harm or potential harm of a minor (anyone under the age of 19 years old), it must be reported to the proper authorities.

• If the client file or this counsellor is subpoenaed, the proper release of information must be provided.

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