Statement of Understanding

We are pleased that you have chosen to begin this journey with us. This form outlines the arrangements with the third-party organization that referred you to our services. If you have any questions or need assistance at any time, please don’t hesitate to reach out. We’re here to support you every step of the way.

Please note the following:

  • A signature is required in one section of this form, which can be completed easily on any mobile device, tablet, or computer.
  • The form does not save progress, so it must be completed in one sitting. It will take approximately 3 minutes to complete.
  • Click Submit when you are done.

If you experience any issues or have questions about this form, please contact our office.

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Thank you for accessing counselling services through the partnership between Your Counselling Ltd and the community partner who has referred you to our services. This partnership will be noted in your welcome email from the Your Counselling Client Services Coordinator. This Statement of Understanding outlines the nature of the services provided, your rights as a client, and key terms of engagement to ensure a transparent and supportive counselling process.

Purpose of Services

The partnership between Your Counselling Ltd and the community partner offers short-term, solution-focused counselling services to eligible individuals. The goal of this service is to provide support for various mental health, emotional, and personal challenges.

 Eligibility and Scope

• Counselling services are available to individuals identified through the Community Partner program.
• Clients are eligible for a limited number of fully-funded sessions. The amounts ( session number) that are available to you will be communicated at your intake session.
• Should further support be required beyond the funded sessions, additional services can be arranged through Your Counselling Ltd at the client’s expense.

Confidentiality

Your privacy is of utmost importance. Information shared during counselling sessions is confidential, with the following exceptions:

• If there is a risk of harm to yourself or others.
• If there is suspicion or disclosure of abuse/neglect involving a child or vulnerable person.
• If records are subpoenaed by a court of law.
• When you provide written consent to share information with a third party.

The third-party agency or community partner that referred you will be notified of your attendance solely for billing purposes. This notification uses a unique, non-identifying number, and billing is processed in batches to safeguard confidentiality. No personal details or information about your sessions will be shared. This system ensures payments are managed efficiently while upholding your privacy and confidentiality in counselling services.

Session Format and Duration

• Counselling sessions may be provided in person, virtually, or via telephone, based on availability and your preference.
• Each session typically lasts 50 minutes.
• Appointment times will be scheduled based on mutual availability.

 Responsibilities of Clients

A standard Your Counselling Intake package is required. A link to complete this will be sent to you.

Limits of Service

While this partnership aims to provide short-term support, it may not meet the needs of individuals requiring:

• Intensive, long-term mental health intervention.
• Crisis or emergency care.
• Specialized services not offered within the scope of this program.

If a counsellor determines that additional or alternative support is required, appropriate referrals will be provided to external services

Consent to Participate

By signing below, you acknowledge that you:

• Understand the nature, scope, and limits of the counselling services provided through the partnership.

• Consent to participate in counselling sessions with Your Counselling Ltd.

• Acknowledge your rights to confidentiality, exceptions to confidentiality, and your responsibilities as a client.

Thank you for trusting Your Counselling Ltd to support your well-being. If you have any questions about this Statement of Understanding or the counselling process, please do not hesitate to ask your counsellor or contact our office directly.

Client File Name

Agreement

I have read and understand the information provided above. I also acknowledge that I can ask questions about this information at any time
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