Catalyst Counselling Services – Intake Form & Informed Consent (In-Person & Virtual Electronic Sessions)
Cancellation Policy
We kindly request that you notify us at least 48 hours in advance if you are unable to attend your scheduled therapy appointment. Failure to do so will result in a charge for the full session’s cost. We appreciate your understanding and cooperation in respecting our cancellation policy, which helps us to provide the best possible care to all of our clients.
Informed Consent for Treatment
Clients Rights
Your initial session will likely involve an evaluation of your needs. As a client, you have the right to ask questions about your counsellor’s training or credentials and discuss any aspect of the treatment approach, concepts, or techniques. By the end of the evaluation, your counsellor will be able to offer some ideas of what your work will include if you decide to continue with therapy.
Confidentiality and its Limits
One of the client’s most important rights involves confidentiality. If your counsellor sees you in public, they will protect your confidentiality by acknowledging you only if you approach them first.
Information revealed during the sessions will be kept strictly confidential and will not be revealed to any other person or agency without your written permission, with the following exceptions: If information is provided where there is reason to suspect abuse, neglect, or molestation of a child, or in the event of a medical or psychological emergency (e.g., clear intention to harm yourself or another person) In the above cases, we are required by provincial law and BC Association of Clinical Counsellors to report and reveal information obtained during the sessions related to the concerns to appropriate agencies without your permission. In rare cases, if a counsellor receives a valid court subpoena, they are legally required to submit the information to the appropriate authority.
If you authorize or request to release the information to a third party. The release of any information is sent within the guidelines set out by the Canadian Psychological Association. It is Catalyst Mind Center’s standard practice to discuss with you in advance when possible if there is a need to disclose information under any of the above circumstances. Counsellors occasionally consult with colleagues from time to time in order to gain assistance and insight in providing quality service. In this consultation, every effort is made to ensure the confidentiality of the client.
Fees and Appointments
Catalyst Mind Center’s counsellors’ rates differ based on their credentials and counselling types. Rates for specific counsellors can be found on their profiles at https://catalystmindcenter.com/en/the-team/
We require all clients to have a current credit card on file before their appointment so we can process payment for appointments.
If you cannot make the scheduled appointment, please contact the office as soon as possible and leave a voicemail. We require a minimum of 48-hour notice of cancellation. You can leave a message on our confidential voicemail. Unless your missed appointment is due to illness or an emergency, you will be charged a total fee for the booked session.
Forms of Contract and Absences
Our counsellors are in the office by appointment only. You can reach them directly through their email or call the office at 604-260-6049 and leave a voicemail. Our administrative staff will direct your call to your counsellor within two business days.
Our counsellors use email for administrative and other purposes. It is best to limit electronic and text clinical communication, as it is not always secure. All email correspondence is printed and becomes part of your clinical file.
Recordings are Prohibited
Clients or the therapists are not allowed to make an audio or video recording of any portion of any in person or virtual appointments.
Informed Consent for Virtual Electronic, Telecommunication Counseling
The purpose of this form is to share some important principles so your decision to proceed in working together can be based on accurate, informed expectations. Please read this carefully and feel free to ask questions if you need clarification.
When I am choosing to have therapeutic counselling sessions through Shining Horizon Counseling via the internet Doxy.me, Zoom, Jane or via Telephone. I understand that:
• I must be at least 18 years old to consent to online counselling or my Guardian does.
• Internet programs are not 100% guaranteed to be secure and confidential. Please review.
• All sessions should be treated like an in-office session. NO outside distractions: Please turn off cell phones and close other computer programs. NO third parties will be in or near the session at any time without the counsellor’s knowledge and approval. Use of headphones are strongly recommended. In couple therapy sessions, it is recommended to have the session in an area that provides total privacy during the session.
• Technical problems may occur. If the call is disrupted, the counsellor will call you back shortly. If video services are not available due to an unplanned equipment or service malfunction, sessions will occur via telephone.
• If reconnection cannot reoccur, the session will be rescheduled through our office. You will receive a phone call during our office hours or an email to reschedule.
• If I am in crisis or an emergency situation that needs immediate attention, where I may be considering harming myself or someone else, I will call 911, contact the Suicide Distress Line at 780-482-4357 or immediately go to the nearest hospital emergency room.
• If I chose to use a platform other than Doxy.me which is suggested by my therapist, such as Skype (wwww.skype.com). I am aware that there might be a higher risk of it not being secured and confidential. Please refer to Skype’s security page: https://support.skype.com/en/faq/FA34649/protecting-your-online-safety-security-and- privacy
Identity Verification
All new clients will have to verify their age and identity by providing a scanned image of their driver’s license or other verifiable governmental identification.
Technology
• I, the client or my guardian, am/is responsible for securing my own computer hardware, internet access points, and password security.
• The therapists or their company is not liable for confidentiality breaches when they are caused by client error.
• The therapist or their company are not responsible for lapses in confidentiality that are in direct response to my own (client’s) actions.
Recordings are Prohibited
• Clients or the therapists are not allowed to make an audio or video recording of any portion of any in person or virtual appointments.
Youth Class Enrolment Agreement
Policies & Procedures
We recommend parents commit to private lessons for the whole term or commit to the full camp in advance in order to reserve your spot. If there are days during the term that you know you will not require lessons, please confirm at the time of booking.
Payments can be made online at the time of booking. Lessons are confirmed once payment is received. Special Payment Plans: If you would like to be considered for a special payment plan, please fill out our payment options form and speak with our administrative staff.
Rescheduling and Cancellation of Private Lessons: We require 48 hours’ notice of any cancellations or requests to reschedule. If less than 48 hours notice, a full payment will be taken. We will carry forward a credit into the following term for lessons that have been cancelled (not rescheduled) 48 hours in advance. No more than 2 cancellations are permitted per term.
Requests to Schedule, Reschedule and Cancel: Any requests to schedule, reschedule or cancel a lesson must be made through your online Jane account. Educators are not responsible for relaying parents’ requests to the office. Parents must not attempt to make ANY arrangements with educators directly. Catalyst Mind Center is not responsible for any lesson changes made directly with educators under any circumstances.
Program Cancellations
In rare cases, an educator may have to cancel a scheduled session. In this case, we will find a substitute educator. In the case where we cannot find a substitute educator, we will provide you with a full refund for the educator’s cancelled lesson.
Direct Contact with Educators:
We do not facilitate the exchange of parent/educator contact information. If you and your educator decide to exchange telephone contact information, it is only for emergency purposes, e.g., if either party is running late to a lesson. Our educators are not ‘on call’ and should not be contacted directly outside of scheduled lesson time for any other purpose.
Group Lessons
Group Lessons are payable in advance for the whole term. Your child’s place in the course is not confirmed until payment is received in full; children may not attend lessons until payment has been received. If signing up partway through a term, the fee for the course will be prorated. We reserve the right not to run an advertised program of study if insufficient students sign up for the course. If payment has already been made for a program that we subsequently decide not to run, we will provide a full refund immediately upon notifying you of the decision.
Rescheduling of Group Lessons:
If your child is unable to attend a scheduled group lesson due to illness or other commitment, your child can catch up on the lesson by attending another equivalent group lesson if space permits. Requests to make up group lessons must go through the learning center office.
Refund Policy
Refund Policy for Camps: We require notice in writing (email) if your child will no longer be attending camp. If written notice of withdrawal is received more than 14 days before the start of the camp, we will provide a full refund less $25 administration fee per child per camp. If written notice of withdrawal is received less than 14 days before the start of the camp, full fees apply. We reserve the right not to run an advertised program of study if insufficient students sign up for the course. If payment has already been made for a program that we subsequently decide not to run, we will provide a full refund immediately upon notifying you of the decision.
Refund Policy for Group Lessons: We require notice in writing (email) if your child will no longer be attending group lessons. If written notice of withdrawal is received less than two days before the start of a program, we will retain 30% of the total fees.
If written notice of withdrawal is received after the start of the program, we will retain 100% of the total fees.
Catalyst Traditional Chinese Medicine Intake and Consent Form
Privacy and Sharing of Information
I authorize the center and its associated health professionals to collect my personal and medical information as documented above and to communicate with my family doctor and/or referring doctor or authorities as deemed necessary for my beneficial treatment and protection. Limits of Confidentiality Information about your sessions will not be released to anyone without your informed, voluntary, and written consent.
I also understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission.
Collecting and Storage of Personal Information: Storage and collection of patient information is in accordance with the Personal Information Protection Act (PIPA) and in accordance with the CCHPBC. Catalyst Mind Center uses Jane Clinic Management System for booking, scheduling, clinical notes, and billing. Jane is Canadian-owned with Canadian servers and is PHIPA and PIPA-compliant. As a patient, you have the right to access information in your records or to obtain a copy of those records at the same charge as at least an hour appointment; if more time is needed by the practitioner for a report, you will be advised prior to the work being done. If requested, your practitioner will provide the information within 5 business days. If you have any questions about this, please ask your practitioner directly.
Cancellation Policy
We kindly request that you notify us at least 48 hours in advance if you are unable to attend your scheduled appointment. Failure to do so will result in a charge for the full session’s cost. We appreciate your understanding and cooperation in respecting our cancellation policy, which helps us to provide the best possible care to all of our patients.
Informed Consent for Treatment
Patients Rights
Your initial session will likely involve an evaluation of your needs. As a patient, you have the right to ask questions about your practitioner’s training or credentials and discuss any aspect of the treatment approach, concepts, or techniques. By the end of the evaluation, your practitioner will be able to offer some ideas of what your work will include if you decide to continue with therapy.
Confidentiality and its Limits
One of the patient’s most important rights involves confidentiality. If your practitioner sees you in public, they will protect your confidentiality by acknowledging you only if you approach them first.
If you authorize or request to release the information to a third party. The release of any information is sent within the guidelines set out by the College of Complementary Health Professionals of British Columbia (CCHPBC). It is Catalyst Mind Center’s standard practice to discuss with you in advance when possible if there is a need to disclose information under any of the above circumstances. Practitioners occasionally consult with colleagues from time to time in order to gain assistance and insight in providing quality service. In this consultation, every effort is made to ensure the confidentiality of the patient.
Fees and Appointments
Catalyst Mind Center’s practitioner’s rates differ based on their credentials and service types. Rates for specific practitioners can be found on their profiles at https://catalystmindcenter.com/about-us-the-team/
We require all patients to have a current credit card on file before their appointment so we can process payment for appointments.
If you cannot make the scheduled appointment, please contact the office as soon as possible and leave a voicemail. We require a minimum of 48-hour notice of cancellation. You can leave a message on our confidential voicemail. Unless your missed appointment is due to illness or an emergency, you will be charged a total fee for the booked session.
Office Hours and Emergencies
Confidential voicemail messages can be left over the weekend, and they will be answered as soon as possible. Therefore, if there is an emergency between sessions, please contact your family physician, the local hospital emergency, 911 or the Crisis Line at 604‐872‐3311.
Forms of Contract and Absences
Our practitioners are in the office by appointment only. You can reach them directly through their email or call the office at 604-260-6049 and leave a voicemail. Our administrative staff will direct your call to your practitioner within two business days.
Our team use email for administrative and other purposes. It is best to limit electronic and text clinical communication, as it is not always secure. All email correspondence is printed and becomes part of your clinical file.
Recordings are Prohibited
Patients or practitioners are not allowed to make an audio or video recording of any portion of any in person or virtual appointments.
Informed Consent for Virtual Electronic, Telecommunication Sessions
The purpose of this form is to share some important principles so your decision to proceed in working together can be based on accurate, informed expectations. Please read this carefully and feel free to ask questions if you need clarification.
When I am choosing to have a session through Catalyst Mind Center via the internet Doxy.me, Zoom, Jane or via Telephone. I understand that:
• I must be at least 18 years old to consent to online wellness session or my Guardian does.
• Internet programs are not 100% guaranteed to be secure and confidential. Please review.
• All sessions should be treated like an in-office session. NO outside distractions: Please turn off cell phones and close other computer programs. NO third parties will be in or near the session at any time without the practitioners knowledge and approval. Use of headphones are strongly recommended. In couple therapy sessions, it is recommended to have the session in an area that provides total privacy during the session.
• Technical problems may occur. If the call is disrupted, the practitioner will call you back shortly. If video services are not available due to an unplanned equipment or service malfunction, sessions will occur via telephone.
• If reconnection cannot reoccur, the session will be rescheduled through our office. You will receive a phone call during our office hours or an email to reschedule.
• If I chose to use a platform other than Doxy.me which is suggested by my therapist, such as Skype (wwww.skype.com). I am aware that there might be a higher risk of it not being secured and confidential. Please refer to Skype’s security page: https://support.skype.com/en/faq/FA34649/protecting-your-online-safety-security-and- privacy
Identity Verification
All new patients will have to verify their age and identity by providing a scanned image of their driver’s license or other verifiable governmental identification.
Promotions and Discounts
From time to time, we may offer promotions, discounts, or special offers (“Promotions”) through our marketing materials, website, or other channels (“Promotional Channels”). All Promotions are subject to availability and may be modified, suspended, or discontinued at any time without prior notice at our sole discretion.
Unless explicitly stated otherwise, only one Promotion may be applied per session, transaction, or customer visit. Promotions cannot be combined with other offers, discounts, or promotional codes.
We reserve the right to verify the eligibility of participants and to withdraw or modify any Promotion in cases of suspected fraud, abuse, or violation of these Terms and Conditions.