Psychotherapy/Counselling Agreement

Psychotherapy occurs within a confidential relationship between a client and a therapist. As with all relationships, there are expectations. The information listed below adheres to the professional requirements of the College of Registered Therapists of Ontario.

Fees and Billing

My fees for individuals are $185.00 and $200/50 min sessions for couple or family appointments. Fees may be raised during treatment. Sessions longer than 50 minutes are charged accordingly. Sessions may be cancelled without charge up to 48 hours prior. Full fees will be charged for missed appointments, or appointments cancelled less than 48 hours prior to the scheduled time. Telephone calls will not be billed unless they exceed about 10 minutes. Under those circumstances, the charge will be the regular session rate according to the time spent. Payment is made by E-transfer to my email address at the end of the session.

Reports, if they prove to be necessary, will incur charges appropriate to the length of the report and time taken for completion. Appointments starting late due to client arriving late will end at the scheduled time. Appointments started late due to the therapist running late will be either extended or pro-rated.

Payment can be made by cash, cheque, or e-mail transfer and is paid at each session or if paid by e-mail transfer, then paid before the session. Psychotherapy services are not covered by OHIP but are often partially or fully covered by employee benefit or other private health insurance plans. The client is advised to check their benefit or insurance plan to ensure compliance with its coverage and claim procedures (eg. whether or not a letter or referral from your physician is required, the details required on receipts, etc. )

Confidentiality and Privacy Policy

The contact between therapist and client is confidential. No information about you will be released to anyone in spoken or written form without your explicit consent. Although personal information disclosed to me is confidential, there are certain exceptions/circumstances in which confidentiality cannot be maintained.

1. If a child has been abused or is being abused, the therapist is required to report this to the Children’s Aid Society.
2. If another regulated health care professional had behaved in a sexually inappropriate manner to a client, patient or colleague, then it is mandatory that the therapist report this to the appropriate college.
3. If a client reports that they are planning to harm themselves or someone else, the therapist has to intervene to ensure that the client and/or another individual are safe.
4. If a therapist is served with a subpoena from court, that is a demand from court to disclose information or records in the context of legal proceedings, then the therapist would be obliged to do so.
5. I may consult with colleagues or a supervisor. Under all circumstances, identifying material will be disguised. In addition, The College of Registered Psychotherapists of Ontario may request to see a file under the College Peer Review Process.

Records

All current records are kept in my office. All others are kept in secure storage for a minimum of ten years after termination of contact in the case of an adult client, and for ten years following the 18th birthday in the case of a minor. All files are kept in a locked file cabinet. No one other than I is allowed to look at client files. Great care is taken when files are being transported.

Availability

I am available for regularly scheduled appointment times. I will do my best to respond to telephone calls in a timely manner (usually no more than 48 hours). In cases of emergency, please contact your family practitioner, telephone your local crisis response line or go to the nearest emergency department.

CONSENT

I have read the Psychotherapy/Counselling Agreement form and am aware of Adele Rezai’s policies regarding confidentiality, fees and billing, availability, record keeping, file retention and privacy. I understand that my therapist is responsible for maintaining all professional standards set forth in the ethical principles of her professional association, as well as the laws of the province of Ontario governing the practice of psychotherapy. I consent to treatment by Adele Rezai, and understand that while many people benefit from therapy, no specific promises have been made about the effectiveness of the intended therapy, or the number of sessions necessary for the therapy to be effective.