Consent for Therapy

Counselling involves taking part in a process of resolving emotional issues with a professionally trained therapist. The process of change will be unique to your particular situation and requires your active and committed participation. In order to achieve the best possible outcome, please read and abide by the following policies and procedures:

ATTENDANCE AND CANCELLATIONS: If you are unable to attend your appointment, you are requested to provide at least 24 hours’ notice. If 2 consecutive sessions are missed without notice, services may be terminated. Missed appointments with less than 24 hours’ notice, regardless of the reason, may be subject to the regular hourly fee.

GUARANTEES: Therapeutic outcomes are contingent upon your readiness to create change and can be impacted by many variables, hence there are no guarantees that desired outcomes will be achieved.

INDEMNITY: The client will hold harmless and indemnify the therapist against any and all claims and actions arising out of participation in the process of therapy (i.e., you will not attempt to sue your therapist should things not go as planned).

TERMINATION: You have the right to terminate therapy at any time, however you are strongly encouraged to discuss this decision with your therapist.

CONFIDENTIALITY: Social Workers only disclose confidential information to other parties (including family members) with the informed consent of clients, clients’ legally authorized representatives or when required by law or court order. The general expectation that Social Workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable and imminent harm to a client or others. In all instances, Social Workers disclose the least amount of confidential information necessary to achieve the desired purpose (the Manitoba College of Social Workers Code of Ethics). Should your therapist become incapacitated or die, arrangements have been made for their Professional Executor to take control of all records related to Room to Breathe Counselling and may contact you to discuss your options.

Consent for Therapy
Preferred contact method (select the option that will provide you with the most privacy, e.g., do not select email if others have access to it) *
Consent *