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Group Therapy Intake & Consent

We are thrilled that you’ve chosen to begin your group therapy journey with us. Completing this intake form is an important first step in creating a supportive and meaningful experience tailored to your needs. In group therapy, your comfort and well-being are our highest priorities, and the information you provide will help us understand your unique circumstances and how to best support you in a group setting. Rest assured, everything shared here is confidential, and we encourage you to take your time as you fill out the form. If you have any questions or need assistance at any point, please reach out—we’re here to support you at every step.

Please note the following:

  • There are two places requiring a signature, which you can complete on any mobile device, tablet, or computer.
  • The form does not save, so it must be completed in one sitting. It should take about 10 minutes.
  • Click “Submit” when done.

If you encounter any issues or have questions, please contact our office.

 

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Personal Information

Full Name
Preferred Contact Method
Address

History and Personal Information

Please complete all fields, put N/A if not applicable.
Request For:
Indicate name, dose and purpose
Marital Status
Provide Name and Phone Number
What is your current occupation and educational history?
Are you involved in any custody, access dispute, disagreement or any legal difficulties

                                      CONSENT 

We encourage you to ask questions regarding your Therapist's education, training and credentials prior to your first session. You can also review their profiles and education by going to: https://www.yourcounselling.ca/get-to-know-us/


Group Therapy Services

Group therapy is a collaborative, shared experience that encourages personal growth through connection with others who face similar challenges. Success in group therapy depends on the active participation and openness of all members, who are both supported by and supportive of each other. Group counselling offers many benefits, such as improved coping strategies, skill-building, reduced distress, enhanced self-esteem, and stronger social connections. However, group therapy can also bring forth complex emotions, such as vulnerability or frustration. Initial sessions are used to assess individual and group needs, and members are encouraged to gauge their comfort with the group setting, as therapy requires a substantial investment of time, energy, and emotional openness.

Confidentiality in Group Therapy

Confidentiality is essential to a safe and trusting group environment. All discussions within the group are strictly confidential, and members are asked to respect the privacy of others by not sharing group content outside of sessions. Information will only be disclosed without written consent in specific cases, including: (a) Duty to Warn, if there is a danger to any individual or in cases of suspected abuse of a child, elder, or vulnerable person; (b) Court Subpoenas, if legal processes require disclosure of group records; and (c) Consultation, where information may be reviewed confidentially with other professionals to enhance group care, with members’ identities protected.

Rules for Participants

To maintain a positive and constructive group experience, all members are expected to adhere to the following rules:

  1. Confidentiality: Respect the privacy of fellow group members by not discussing any identifying details or personal information outside of the group.
  2. Respect: Engage in respectful, non-judgmental listening and speaking. Refrain from interrupting, giving unsolicited advice, or engaging in confrontational behavior.
  3. Punctuality and Consistency: Arrive on time and attend all scheduled sessions. Consistent attendance supports group cohesion and builds trust.
  4. Participation: Actively participate in discussions and activities, to the extent of your comfort level. Open sharing enhances both individual and group growth.
  5. Boundaries: Respect personal boundaries, including refraining from physical contact or discussing sensitive issues if someone is uncomfortable.
  6. Feedback: Offer constructive feedback, when appropriate, and be open to receiving feedback from both the therapist and group members in a supportive manner.
  7. Focus on the Present: Keep discussions focused on current experiences, thoughts, and feelings, as this encourages meaningful, relevant connections within the group.
  8. For virtual group sessions, please join from a confidential and private space. Ensure cameras are on throughout the session to support group confidentiality, and please refrain from recording or taking photos of any participants

Breaking these rules can impact the group’s progress and may lead to a discussion with the therapist about continuing participation.

Members’ Rights in Group Therapy

Group members have the right to ask questions about any aspect of the group process, and therapists are open to discussing their methods. Members may request adjustments or opt out of specific activities if they feel uncomfortable. Members may also inquire about the therapist’s qualifications and discuss the option of individual therapy if group therapy feels unsuitable. Participants are free to discontinue group therapy at any time, though a termination session is recommended to provide closure.

Record Keeping for Group Therapy

Group therapy records are maintained digitally and in accordance with professional standards, including documentation of attendance, general discussion themes, and therapeutic interventions. Individual records may also be held digitally and are accessible only in the presence of the therapist. Members may request corrections to their records if needed. All records are securely stored for seven years following the final session, with strict confidentiality upheld.

Contacting Your Therapist

Group therapists may not always be immediately available by phone but will typically return messages within 36 hours and respond to emails in the same timeframe. For extended absences, alternate contact information will be provided. Administrative support is available Monday through Friday for scheduling assistance.

Emergencies

In case of an emergency outside of group therapy sessions, members are advised to contact the Distress Centre Calgary at 403-266-4357, visit the nearest Emergency Room or Urgent Care Center, or call 911.

Clinic Structure

Therapists facilitating group sessions under "Your Counselling Ltd" operate as independent practitioners. While they may collaborate on clinical or business matters, each therapist functions autonomously. Any concerns or questions should be addressed directly with the respective therapist. Contact details for the therapist’s professional governing body can be provided upon request.

Clear Signature
Upon signing, you are indicating that you have read and understood this consent form. You agree to accept the counselling services as detailed above.

Fee Schedule 

Effective July 18, 2023 

Standard Rates/Fees for Group Therapy

Group Therapy Sessions:

May 2025: Radical Self-Compassion    $ 300.00 for 2 Group Sessions

A hold payment of $150.00 is due at the time of registration. After this there are two options for payment:

Option A: The full amount remaining can be paid at once.

Option B:  Payment can be made after each session.

Participants are expected to attend all sessions to gain the full benefits of the program. If you are unable to attend a session, the fee remains unchanged, no refunds will be made for missed sessions. By signing this form you are committing to the total cost of the series. 

While we offer direct billing to various insurance companies, we cannot confirm your level or type of coverage since we do not have access to this information. Any balance not covered by direct billing is due at the end of the session.

Cancellation and Missed Appointment Policy for Group Therapy

Group therapy sessions are valuable for both the individual and the group as a whole. When one participant cancels on short notice or misses a session, it can impact the group dynamic and make it difficult to maintain continuity. The following outlines how missed and late-cancelled appointments are handled:

  • Cancellations made after May 15, 2025  will still be subject to the full fee.
  • Cancellations must be confirmed by either our booking system or admin team to ensure the session is successfully canceled.
  • Clients who do not show up for a scheduled session (“no show”) are responsible for the full cost of that session.
  • Our booking system will send reminder emails as a courtesy; however, clients are responsible for keeping or canceling appointments regardless of receiving a reminder.

Exceptions to the Cancellation Policy

Missed appointments and late cancellations are payable via debit, credit, cash, or e-transfer before the next session. Receipts for these charges are labeled as “cancellation fee” or “missed appointment” and cannot be marked as a “counselling session.” We cannot direct bill insurance for missed or late-cancelled appointments.

Clients with overdue invoices cannot book further sessions ( regardless of the type)  until their accounts are settled.

Payment Option
Clear Signature
By signing above, you are indicating that you have read and understood the fee agreement