Consent for Online Counseling Service

Online therapy is a form of psychotherapy service provided via internet technology, which can include consultation, treatment, emails, telephone conversations and/or education using interactive audio, video, or data communications.
I understand that online therapy involves the communication of sensitive personal information, both verbally and/or visually. Online therapy has the same purpose or intention as psychotherapy or psychological treatment sessions that are conducted in person. However, due to the nature of the technology used, I understand that online therapy may be experienced somewhat differently than face-to-face treatment sessions.
Description of Session Durations
I, Hossein Haji Ghafari, have a Masters in Counselling and am a member in good standing with the BCACC (British Columbia Association of Clinical Counsellors). My registration number is 22073.
At Hossein H Ghafari counselling, I provide mental health counselling services to individuals. First and foremost, I work from a personcentered framework as I believe in the resilience of each person and aim to work alongside my clients in their personal explorations rather than seeing myself as the expert. I strive to keep up-to-date with the latest trainings in the fields of mental health and counselling psychology.
The counselling relationship is a strictly professional relationship. That means that the counsellor and client will not engage in any other relations, even after therapy is finished. This includes friendship, romantic relationship, business relationship, social media (Facebook, Instagram) or any other form of connecting outside the counselling space.
Client’s Rights, Risks, and Responsibilities:
1. I, the client, am a resident of British Columbia.
2. I, the client, have the right to withhold or withdraw consent at any time without affecting my right to future care or treatment.
3. The laws that protect the confidentiality of my personal information also apply to online therapy. As such, I understand that the information disclosed by me during the course of my therapy or consultation is generally confidential. However, there are exceptions to confidentiality such as if the following circumstances arise:
• The client is in imminent danger of harm to self or others
• Child abuse is suspected of occurring
• If ordered by law or court subpoena
4. I understand that there are risks and consequences of participating in online therapy, including, but not limited to, the possibility, that: the transmission of my information could be disrupted or distorted by technical failures; the transmission of my information could be interrupted by unauthorized persons; and/or the electronic storage of my medical information could be accessed by unauthorized persons.
5. There is a risk that services could be disrupted or distorted by unforeseen technical problems.
6. I understand that Heidi Stokes Counselling uses Zoom as an online platform and cannot guarantee the complete privacy and confidentiality of information shared through this platform.
7. I understand that I may benefit from online therapy, but that results cannot be guaranteed or assured.
8. I accept that online therapy does not provide emergency services. If I am experiencing an emergency situation, I understand that I can call 911 or proceed to the nearest hospital emergency room for help.
Personal Records 
Personal information collected for counselling will be stored in a locked file and destroyed after 10 years from the last point of contact (if the client is over the age of 18) or 10 years after the client turns 18 or 10 years after the last point of contact (if the client is under the age of 18), whichever is greater. As the client, you can request to view your personal records.
Complaints 
If you have concerns about the competency or professionalism of services received at Heidi Stokes Counselling, you are encouraged to discuss this with Heidi Stokes. If your concerns are not addressed to satisfaction, you have the right to file a written complaint with the BC Association of Clinical Counsellors (BCACC).
Fees
Online counselling sessions are charged at $130 per 50-minute session. Fees can be paid in cash, e-transfer or credit card at the beginning of each session. I require 48 hours cancellation notice, otherwise you will be charged the full session fee.
Some extended health care benefits cover counselling by RCCs. Please check with your health care provider to determine what is covered in your plan. Receipts can be obtained to submit to your healthcare provider.