Privacy, Confidentiality and Informed Consent Form - Tatiana Carballo Therapy

Potential Risks and Benefits

Engaging in therapy can offer significant benefits, such as improved relationships, enhanced emotional well-being, and effective solutions to specific problems. However, therapy can also bring up difficult emotions and memories, which might cause discomfort before improvement is noticed. As clients explore new ways of thinking and behaving, they may experience shifts in their relationships or other aspects of life. It is important to communicate any concerns or discomfort during the therapeutic process to your therapist at any time.

Collection and Storage of Personal Information

Tatiana Carballo Therapy maintains records of your sessions, which are securely stored per legal and ethical standards. These records are kept confidential and are only accessible to authorized personnel as required by applicable laws and professional guidelines.

Fees and Payment

We offer a complimentary 15-minute initial consultation via phone to discuss your needs and determine if our services are the right fit for you. Our standard fee for a 50-minute session is $140, with GST applied where applicable. Payment is required after each session and can be made using major credit cards, PayPal, or e-transfer.

If you need to reschedule or cancel an appointment, please provide at least 24 hours' notice. Cancellations with less than 24 hours' notice will incur a charge of 75% of the session fee.

Technical Considerations

While we strive to provide uninterrupted online therapy sessions, there is always a possibility of technical issues, such as poor internet connections. In the event of such issues, we will attempt to reconnect or reschedule the session. If you are unable to connect within 15 minutes of the scheduled time, you may be eligible for a session credit.

Client Rights

As a client, you have the right to:

  • Decline any specific therapeutic techniques or discontinue therapy at any time.
  • Request a referral to another therapist or healthcare professional.
  • Withdraw or withhold consent for the collection or use of your personal information, except where required by law.
  • Access or request a copy of your therapy records, subject to legal requirements.
  • Ask questions about the therapy process, your therapist's qualifications, or any other concerns that may affect your participation in therapy.

Confidentiality

All information shared during therapy is strictly confidential and will not be disclosed without your written consent. However, there are certain legal and ethical exceptions, including:

  • Reporting suspected child abuse or neglect.
  • Complying with legal requirements, such as a court order.
  • Addressing situations where there is a threat of harm to yourself or others.

While we take measures to secure online communications, please be aware that online platforms may not be 100% secure. We use encrypted software to enhance security, but it is important for you to take steps to protect your privacy as well.

Agreement

By signing below, you acknowledge that you have read, understood, and agree to the terms outlined in this document, and you consent to participate in therapy.

Moyen de paiement

Mois d'expiration
Année d'expiration

Please sign and complete ALL required fields.

Je certifie que les informations ci-dessus sont complètes et exactes. Je reconnais que les informations contenues dans ce formulaire seront conservées en toute sécurité et encryptées sur le site Web de Colib, consultable par l'organisation que je prévois visiter.

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