Informed Consent

I am a graduate of Clearmind international. My designation is Registered Therapeutic Counsellor (RTC) and I am registered with the Association of Cooperative Counselling Therapists of Canada (ACCT) and regulated by the ACCT Code of Ethics and Standards of Practice which is designed to protect the client. Any complaint of a serious and ethical nature, not business complaints, should be directed to ACCT. ( I encourage any upset be brought to me personally before going forward. Please know I am very open and would address any upset with you. If we cannot come to terms, then you can contact my association.

  • At all times I am guided by my Ethics around confidentiality. One part of that is how I keep confidentiality outside my office. I will not approach a client in a public place; however, it is fine if the client wishes to do so. This is done to protect the client’s privacy.
  • As a Counsellor who works hard to bring my best self to my client, I regularly take my clients information to my Supervisor to insure the best possible considerations and outcomes. The client’s name is never used or identified in the supervision.
  • I counsel from a combination of perspectives that include Bowen Family Systems Theory (who you became in the family you grew up in); Person centered therapy (enabling you to accept more of who you are as a person and able to reconnect with your own values and self-worth);Gestalt therapy (concentrating on the ‘here and now’ experiences to remove obstacles created by past experiences); and Transpersonal counselling which centers on the spiritual aspects of human life.
  • I also believe in take-away assignments on occasion as I feel it helps bring continuity to our learning in the sessions and enables the client to practise what was just learned.
  • If at any time during our professional relationship I feel that what is being brought to session is outside the scope of my practise, I reserve the right to refer the client to someone else, or inform them of things that I cannot help them with.

Third Party Confidentiality

All of the information that we share together is strictly confidential unless one of the following should occur:

1. The courts subpoena my files.

2. I am subpoenaed as a witness in court.

3. I suspect cases of child, elder or other abuse that have not been previously reported. This includes physical harm, sexual abuse, sexual exploitation, and emotional harm. In this case I am required by law to report to the Ministry for Children and Families.

4. If you threaten to harm yourself or another or if you or the counsellor is in harm’s way or at risk. In this case I am also required to report this to the proper authorities.

5. A medical emergency where a doctor or attendant requires medication or medical history.

Professional referral:

At times a client might need a referral to a specialist in regards to medications, special care, etc. This would be considered by the Counsellor and client together.


As I am seeing clients outside of my Province or Country, it is important to understand that my designation (Registered Therapeutic Counsellor – RTC) is applicable to the Province of B.C. in Canada and the meaning of this designation might be different in another area.

Business Policies

  • Referrals: I would be happy to accept client referrals. The person needing help would need to contact me personally with my email: or phone my office at 250-889-6002. It is not appropriate for me to contact the person making the referral in accordance with my new client’s confidentiality.
  • Illness / death or emergency with Counsellor: In order to protect your privacy to the best of my ability, I would arrange to have your files stored by another Counsellor who would notify you of my state. If I would be gone long term then arrangements could be made to refer you to someone else and your files available for them. Or, the person I designate to notify you could carry on with your care. All files still remain private and confidential.
  • Holidays: you will be given two weeks’ notice when your Counsellor will take holiday time.
  • Office hours: Monday to Friday 9:00am to 5:00pm Pacific time, unless otherwise arranged. I typically respond to emails or calls within a 24-hr. period through the business week.

Client’s Rights and Responsibilities:

Countryside Counselling is a place of sharing and healing in an atmosphere of privacy and confidentiality. However, the work we do together can at times feel difficult or challenging before we start to see results. This is normal. However, if at any time you find yourself in “crisis”, please call the Crisis line 1-888-494-3888 (Vancouver Island Crisis Line) or your local Crisis number, or dial 911. Similarly, after choosing to participate in an experiential process there can be vulnerable feelings arise at which time you would either make an appointment with your Counsellor or if in “crisis”, call the above number. Always keep your Counsellor informed of these occurrences.

  • Ask questions regarding direction of your sessions
  • Be open to taking steps that could benefit you.
  • Know that the final decision is always yours regarding taking any experiential steps
  • Follow policies and agreements as laid out within this document.
  • Adhere to mutual confidentiality in regards to theory taught or personal sharing on the part of client and counsellor
  • Recording of sessions is NOT allowed. All session information is to be mutually confidential.
  • Insure that your emergency information is up-to-date at all times. Any changes should be given to your counsellor as soon as possible.
  • You as the client understands that I do not work with individuals who have existing or pending custody lawsuits, accident or injury insurance claims such as ICBC or Work Safe B.C. If while already working with me, an event occurs that results in legal work or accident or insurance claims of any nature, I should be informed immediately to discuss this prior to your next session.

Financial and Administrative Terms and Policies

  • Fees: 60 min. session – $100 (no tax)
    90 min. session – $125 (no tax)
  • Fees must be paid in advance
  • All fees are payable in Canadian funds
  • If an accident, injury or illness happens within the 24-hours prior to a session, which was unforeseeable and unpreventable, the advanced payment can be used in another appointment.

Online sessions:

  • All payments due a minimum of 24 hrs. prior to sessions. A $10 late payment fee will be charged.
  • Invoices will be sent in advance of the session, allowing for a minimum of 24 hour advance payment by client.
  • Preferred method of payment is E-Transfer, but can also be made via credit card payment through PayPal. PayPal issues a full receipt when you make payment. You do not need a PayPal account in order to make a credit card payment.
  • I will always initiate online contact when a session is set up

In-person sessions:

  • Payment can be made in cash cash can be made at time of appointment or when coming for an in-person session. 
  • Credit card payment through PayPal is due within 24-hours of session. PayPal issues a receipt when you make payment.
  • Receipts for cheque or cash payments for sessions will be given after a session, if required.

Lateness Policy

  • If the client is late for an appointment, the time will start as designated and end as originally designated as well and the fee is the same. After 30 minutes the session is forfeited and full payment is due.
  • If I, the Counsellor, is late I will deduct a portion of the fee for next session or we can extend our session time to compensate for the time I was late. The fee remains the same.
  • If you, the client, is trying to determine if you should keep an appointment although feeling ill, please err on the side of conservative and cancel your session with 24 hours’ notice and we can re-schedule when you are well.
  •  If the Counsellor is unexpectedly sick, I will also give 24 hours’ notice and your session will be deferred to a mutually agreeable date.

  • On rare occasions an emergency or accident could prevent you or me from giving the required 24 hr. notice to cancel or schedule a session (ie power failure, car accident). An emergency would be deemed as unforeseeable or unpreventable that has occurred within the last 24 hrs. the nature of which would not allow you to give proper notice of cancellation. Therefore the cancelling fee does not apply. This does not include on-going sickness, conflicting schedules or something that has been present for more than 24 hrs.

  • “No show” policy – you will be charged for the full session if you have not let me know 24 hr. in advance.

  • Re-scheduling – we strongly recommend that re-scheduling is kept to a minimum as it’s very important for you to have consistency in order for you to see progress. It is often not understood that chronic re-scheduling is a method of self-sabotage. Cancellation and re-scheduling both require 24 hours’ notice.

Contact between sessions

  • Contact can be made through text or phone for administration purposes only – rescheduling or booking sessions for example.
  • Anything of a personal nature will be discussed in sessions only. If something does get directed to me in an email, it will be printed and put in your file to be discussed at our next session together. If you are feeling in a state of an emergency, please book an emergency session.
  • Social media –you are welcome to connect with me on my business Facebook page. My personal Facebook page is for my personal life and I limit that to family and friends. Please do not message me through Facebook or Skype – contact me through my business email or phone please.

Termination of Sessions

  • If possible, I would appreciate knowing if you plan on discontinuing sessions or plan on returning at some point. This gives me the opportunity to summarize your “gains” and bring our time to a closure. It allows us to make a plan for you going forward and that support is always available.


Insurance Coverage

Provincial or other health care plans may not cover the cost of counselling. However you may want to contact your extended health care plans prior to making an appointment. If you have coverage, you will be required to pay for the counselling session and then submit your receipt to your extended healthcare plan for reimbursement.

Alcohol and Drug Intolerance

If you come to session under the influence of either recreational drugs or alcohol, the session would be cancelled. Prescription drugs are acceptable.


Because online sessions include world-wide, it should be understood that the laws and guidelines only cover the Municipality, Province and Country and Professional Association in which Countryside Counselling is registered (B.C., Canada). It is agreed that the laws or guidelines of other regions or countries will not apply.

Technology Issues

  • My preferred method of an online program is called ZOOM. We meet in an online meeting room. It is a simple product which does not require the client to download or purchase, however there can be difficulties beyond our control. Power outages are possible either with the practitioner or the client. In this case, we would text and make other arrangements or establish another appointment time. The client is responsible for their own computer as is the counsellor. Please connect to the modem for full internet strength so we can have uninterrupted sessions.

Client Notes

  • Client notes can include Voicemail, email, text as well as written notes. There is always an element of risk with on-line in that we sometimes divulge information we wouldn’t want seen by the public.
  • Please be mindful that email is not considered a confidential way of communicating, therefore only email information you would be comfortable discussing in a public space.
  • In counselling, the client does have a right to access their file, of which they must notify me and we will set up a time to go through that file together, in a paid session. You can request for your file to be sent to another practitioner but I will require a release form and you will have to pay for that file to be copied because I am the custodian of your file.

Email and Newsletter Lists

  • Please note that you will be added to one or both of these Lists, but you always have the option of unsubscribing.
  • Countryside Counselling reserves the right to change Rates or Policies from time to time, with a months’ notice. For clients who are currently working with me in session, I would email a copy of the changes and ask for a signature acknowledgement of those changes. For new or returning clients, it is important to re-read the Policies to familiarize yourself with any ongoing changes.


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