Client Consent and Service Agreement

This is important information about professional services and policies of Healing Your Body by Healing Your Mind. It contains summary information about the terms “we”, “us”, “our” “practitioner “, and “Healing Your Body by Healing Your Mind” refer to the person providing the service to you. The term “you”, “client” or “patient” refers to any person or entity that visits our practice or contributes, is present or takes part in a session.

The documents are long and sometimes complicated, it is essential that you understand them. When you agree to this document, it will then form an agreement between You (the client) and Us (Healing Your Body by Healing Your Mind). We can answer any questions you have at the time of consent or at any time in the future. The service provided is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As a client of Healing Your Body by Healing Your Mind, you have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights that you should be aware of.

Healing Your Body by Healing Your Mind, have corresponding responsibilities to you. These rights and responsibilities are described in the following sections.

Goals/outcomes of treatment

There can be many goals for the client relationship. Some of these will be long term goals such as improving the quality of your life, learning to live with mindfulness and self-actualisation. Others may be more immediate goals such as decreasing anxiety and depression symptoms, developing healthy relationships, changing behaviour or decreasing/ending drug use. Whatever the goals for the service, they will be set by the clients according to what they want to work on in the session. Healing Your Body by Healing Your Mind may make suggestions on how to reach that goal, but you decide where you want to go.

Risks/Benefits of Services

Sessions are an intensely personal process which can bring unpleasant memories or emotions to the surface. There are no guarantees that the session will work for you. Clients can sometimes make improvements only to revert after a time. Progress may happen slowly. All our services require a regularly active effort on your part. To be most successful, you will have to work on things we discuss outside of sessions. However, there are many benefits to the sessions.

Our services can help you develop coping skills, make behavioural changes, reduce symptoms of mental health disorders, improve the quality of your life, learn to manage anger, learn to live in the present and many other advantages.

Appointments

Appointments will ordinarily be 30-60 minutes in duration; initial sessions may be up to 90 minutes, may be as often as once per week at a time we agree on, although some sessions may be more or less frequent as needed. The time scheduled for your appointment is assigned to you and you alone. If you need to cancel or reschedule a session, we ask that you provide a minimum notice of 12 hours. If you miss a session without cancelling or cancel with less than 12 hours notice, you may be required to pay for the session [unless we both agree that you were unable to attend due to circumstances beyond your control]. you will be responsible for the cancellation fee. In addition, you are responsible for coming to your session on time; if you are late, your appointment will still need to end on time.

Confidentiality

Healing Your Body by Healing Your Mind will make every effort to keep your personal information private. If you wish to have information released, you will be required to sign a consent form before such information will be released. There are some limitations to confidentiality to which you need to be aware. We may consult with a supervisor or other professionals in our practice to give you the best service. In the event that we consult with another practitioner, no identifying information such as your name would be released.

Healing Your Body by Healing Your Mind is required by law to release information when the client poses a risk to themselves or others and in cases of abuse to children or the elderly. If Healing Your Body by Healing Your Mind receives a court order or subpoena, we may be required to release some information. In such a case, we will consult with other professionals and limit the release to only what is necessary by law.

Confidentiality and Group Therapy

The nature of group therapy makes it difficult to maintain confidentiality. If you choose to participate in group therapy, be aware that your Healing Your Body by Healing Your Mind cannot guarantee that other group members will maintain your confidentiality. However, we will make every effort to maintain your confidentiality by reminding group members frequently of the importance of keeping what is said in group confidential. We also have the right to remove any group member from the group should she discover that a group member has violated the confidentiality rule.

Confidentiality and Technology

Some clients may choose to use technology in their sessions. This includes but is not limited to online sessions via Skype, Zoom, telephone, email, text or chat. Due to the nature of online sessions, there is always the possibility that unauthorised persons may attempt to discover your personal information. Healing Your Body by Healing Your Mind will take every precaution to safeguard your information but cannot guarantee that unauthorised access to electronic communications could not occur. Please be advised to take precautions in regard to authorised and unauthorised access to any technology used in sessions. Be aware of any friends, family members, significant others or co-workers who may have access to your computer, phone or other technology used in your session.

Record-Keeping

Healing Your Body by Healing Your Mind may keep records of your sessions and a treatment plan which includes goals for your session. These records are kept ensuring a direction to your sessions and continuity in service. They will not be shared except with respect to the limits to confidentiality discussed in the Confidentiality section. Should the client wish to have their records released, they are required to sign a release of information which specifies what information is to be released and to whom.

Records will be kept for at least 7 years but may be kept for longer. Records will be kept either electronically on a USB flash drive or electronically on it’s online servers or client portals.

Professional Fees

You are responsible for paying at the time of your session unless prior arrangements have been made. Payment must be made by credit card or cash. If you refuse to pay your debt, we reserve the right to use an attorney or collection agency to secure payment. If you anticipate becoming involved in a court case, I recommend that we discuss this fully before you waive your right to confidentiality. If your case requires our participation, you will be expected to pay for the professional time required. Fees are non-negotiable. To receive sliding scale fees, you must present proof of income through recent pay stubs or tax forms. Fees are subject to change at Healing Your Body by Healing Your Mind discretion.

Fee Schedule

Initial session fees start at $160 depending on the service provided.

Returning session fees start at $60 depending on the service provided.

We may, at times, offer discounted sessions or packages.

Our full fee structure can be found on our website on the appointments page. We reserve the right to change this consent from time to time.