THERAPY CONSENT FORM
(For both Online and In-Person Therapy)
Definition of Services:
Therapy includes sessions where I can talk with a licensed professional to get help for my mental health. These sessions can happen in-person or online using video calls, emails or phone calls. Both types of therapy have the same goal: to improve my mental health and well-being. Online therapy may feel different from in-person therapy because it uses technology, but the purpose is the same.
Client’s Rights, Risks and Responsibilities:
Location Requirement:
For online therapy, I must live in Ontario. (This is required for insurance ) There is no location restriction for in-person therapy as long as I meet the therapist in their office.
Consent:
I can stop or change my consent for therapy at any time without affecting my future care or treatment.
Confidentiality:
My personal information is private. The same laws protect my privacy for both in-person and online therapy. However, there are certain situations where my therapist must or can share information (for example, if there is a risk of harm). These situations were explained in the general Consent Form I got at the start of therapy.
Risks:
In-person therapy risks: Someone might recognize me entering or leaving the therapist’s office.
Online therapy risks: My information could be interrupted by technical problems. Someone without permission could access my information.
My medical information could be seen by unauthorized people.
Technical Problems (Online Therapy): My session could be interrupted or stopped because of technology issues like internet problems.
Therapy Limitations: Therapy, whether in-person or online, may not always feel complete. If my therapist believes I would do better with a different type of therapy, they will recommend other options.
No Guarantees: Therapy may help me, but results are not guaranteed. There are risks and benefits with any therapy. Even with hard work, my condition might not improve or could even get worse.
Emergency Situations: Therapy is not for emergencies. If I am in an emergency, I will call 911 or go to the nearest hospital. If I have thoughts of harming myself, I can call the Crisis Centre at 1-800-784-2433 for free, 24/7 support.
Privacy: For online therapy, I will make sure I am in a private, quiet room with good lighting and no distractions. My therapist will do the same on their end. For in-person therapy, my therapist will ensure my sessions are private and confidential.
Recording Sessions: Therapy sessions will not be recorded or shared without my clear permission.