Prior to your first session, I ask that you complete the Informed Consent form, the Intake Questionnaire form, and the Cancellation Policy form relevant to the service that you are seeking. Any personal information collected through these forms is kept strictly confidential. You might find that completing these forms before our first appointment session allows you to ease into and gain clarity about the process, and gives us a bit of a head start. With these intake forms completed before our first session, we can spend more time together in our first session focusing on you or your child. Please let me know if you require any assistance, or if you have any questions or concerns about completing these forms.
- If we are meeting face-to-face, you may bring the completed forms with you to your first appointment, return them by secure email to email@example.com prior to your first visit, or fill out the forms when you arrive to your first session.
- If we are meeting online or by phone, please return the completed forms to me by secure email to firstname.lastname@example.org. If you are unable to complete the forms and/or return the completed forms to me email prior to our first telepsychology appointment, we will complete the forms together during our first session.
Informed Consent Forms
Your autonomy and fully informed consent is really important to me. I want to ensure that you have all the information that you might need to make the best choices for yourself or your child. Whether we are meeting face-to-face, online, or by phone, all services are completely voluntary and there are many factors related to engaging in psychological services that are really important to consider. I understand that engaging in psychological services can sometimes feel scary---it involves being vulnerable in a really personal way! If there is anything that you feel uncertain or uneasy about or if you would like to clarify anything further before commencing any kind of psychological services, please let me know. Your safety is my top priority, and I want this process to feel empowering, supportive, and respectful. Also remember that consent is an ongoing process, meaning that we may revisit topics around consent at any time. Click on the link below to access the Consent Form applicable to the service that you're seeking:
Intake Questionnaire Forms
When beginning counselling or psychological assessment work, sometimes it's hard to know where to start. Intake Questionnaires are intentionally prepared to help gather relevant information, help you ease into the therapeutic process, and gently begin to introduce me to your personal world, what life has been like so far, what your hopes are for the future, and other information, in a structured and concise way. The items in these questionnaires also provide me with important information for understanding and bringing more insight into your or child's development, preferences, therapy or assessment goals, and treatment planning. The items included in the questionnaire are meant to help both you and me to gain clarity and insight about your history, your background, any challenges you might be facing, what you hope to gain from working together, and any past or present information that might be relevant to our sessions and work together. This is also an opportunity to begin to explore, think about, and share with me, any information that you feel is important. If there is more information that you would like to share with me that is not included in the questionnaire, feel free to add in any information that you feel is important for me to know. If there are any items that you come across in the questionnaire that you are not sure how to answer, or do not feel comfortable answering, feel free to provide your best answer, contact me for clarification, or skip the question and I will follow up with you about it in our session together. Some of the questions on the questionnaire might bring up uncomfortable memories, thoughts, or emotions. If you would like support, please contact me. Take your time, and only answer what you feel comfortable to share. Click on the link below to access the Questionnaire Form applicable to the service that you're seeking:
Cancellation Policy Form
Psychological treatments are complex, and crucial to our individual and collective health. To provide you with a high standard of care, attention, and support, psychologists work diligently before, during, and after your scheduled appointment time, preparing for the important work that we do together. Your scheduled appointment time is specially reserved just for you. You are free to make changes to your scheduled appointments at any time; however, I ask that you provide me with at least 24 hours' notice to make a change, cancellation, or reschedule an appointment, so that the otherwise reserved appointment time might be made available to someone else. To make, change, or cancel an appointment, contact me by phone, text, or email. Please note that for any psychological service, a fee may apply for cancellations, changes, or rescheduled appointments made with less than 24 hours' notice. For this reason, credit card information is requested in order to secure your appointment. As with any and all personal information collected, this information is kept strictly confidential and will not be shared or used without your prior expressed and informed consent. Please let me know if you have any questions or concerns. If you are unable to send this form back to me in a secure way, you may verbally share your credit card information with me by phone-call or in our first appointment. Click on the link below to access the Cancellation Policy Form: