Forms

Confidentiality Policy and Privacy

capABILITY FIRST recognizes that the information you provide is private, and we are committed to keeping that information confidential.

Your record will be securely stored, and no information will be released from your counselling record without your consent; except in the circumstances described in Limits of Confidentiality sections below.

Limits of Confidentiality

Counselling Services is legally obligated to disclose information about you to the appropriate authorities, with or without your consent, in the following circumstances:

  • There are reasonable grounds to believe that you are likely to harm yourself or another person.
  • There are reasonable grounds to believe that a child under the age of 17 years is at risk of being abused or neglected.
  • Your counselling record has been subpoenaed by a court of law.
  • You disclose that you have been sexually abused by a regulated health professional.

If you have any questions or concerns about these policies, please feel free to discuss them with a member of capABILITY FIRST team.

If you are a new client, please complete the forms below prior to your first session. You may leave blank any questions that you do not feel comfortable answering.

Client Intake Form
Client Consent Form

Please complete this form if you would like me to coordinate care with another provider, such as your physician or psychiatrist. This will allow your circle of care to work together and therefore, share necessary information.

Authorization to Disclose Information