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  • Consent To Psychological Services


    Psychological services are confidential by law. You must provide written consent to discuss or release any information to another individual or external agency. There are several limits to confidentiality, as follows:

    • If you pose an imminent risk to yourself or to another person, including driving while intoxicated.
    • If you disclose that a child is being abused or is at risk of harm.
    • If you disclose that you were abused by a regulated health care professional.
    • If your file is subpoenaed by court or you are involved in a current or future legal case or disability claim.
    • If release is required in a proceeding of the College of Psychologists of Ontario
    • If release is required under the Long Term Care Homes Act and The Retirement Homes Act

    You should be aware that The College of Psychologists of Ontario may audit clinical records to ensure compliance with regulatory standards of the profession. If an insurance company is seeking billing verification, we will only release information related to participant name, treatment date, length of session, and fees paid. Finally, we participate in peer consultation. Although it is possible that your treatment might be discussed during consultation, we would not provide any identifying information.

    Benefits and Risks of Psychological Services

    Psychological assessment and therapy can occasionally elicit difficult or distressing emotions or changes can impact relationships.Conversely, psychological assessment and therapy can help individuals find relief and new ways of coping and problem-solving, and to experience positive and lasting personal changes.

    Privacy, Record Keeping, and Electronic Communication

    The storage, retention, and destruction of your personal information comply with existing legislation and privacy protection protocols and with Standards of College of Psychologists of Ontario. Your file will be stored in a locked cabinet and will be kept for at least 10 years after your last date of contact. Electronic communication cannot be guaranteedto be secure and there are inherent risks in transmitting personal information via the web, texts or emails. Please be aware of the risk if sending personal information through emails or texts. Please limit your emails to scheduling or cancelling of appointments. We use asecure practice management software which allows for scheduling of appointments and automatic appointment reminders through texts and emails. It also allows us to email you with invoices and receipts of services. Occasionally, we may provide Teletherapy via a secure, confidential Internet service – if interested please discuss with your therapist.


    Our fees for psychological services fall within the guidelines set forth by the Ontario Psychological Association. Fees for psychological services are not covered by OHIP but may be reimbursable through your own or your spouse’s Extended Health Care Plans. Coverage varies and some insurance companies require a physician’s referral. Fees may also be covered by some Third Party Payers such as the Workplace Safety and Insurance Board, Auto Insurance Companies, Veterans Affairs, Non-Insured Health Benefits for First Nations, or the Criminal Injuries Compensation Board. Additional services such as completion of reports and forms or telephone consultations may be billed at the hourly rate. This can be discussed with the practitioner if required. The responsibility of payment for all invoices remains with the client, independent of any third-party coverage. You are responsible for inquiring about and managing your coverage. The service provider will provide reasonable assistance required to facilitate the reimbursement to the client of all legitimate costs through third party coverage.

    Supervision Agreement

    Occasionally, psychological services are provided by a qualified therapist/counsellor under the supervision of a registered psychologist. Supervision follows the Standards of Professional Conduct set forth by the College of Psychologists of Ontario (CPO), of Professional Conduct.arspx. The supervising psychologist assumes responsibility and accountability for all services provided by the therapist/counsellor and meetings between you and the supervising psychologist may occur at your request, the therapist’s request, or the request of the supervising psychologist. Please note that some third-party payers and extended health care plans do not provide coverage for services provided under the supervision of a registered psychologist.


    Payment is due at the end of each session/appointment. The method of payment is Cash, Cheque, Visa, and MasterCard. Please note that if you provide us with a credit card number for payment, you authorize us to process payment via a secure software for services rendered. There will be an additional charge of $50.00 for NSF cheques. Upon receipt or processing of payment you will be provided with a receipt via email or a paper copy if you do not have access to a printer, which you can submit to your insurance company for reimbursement if you have extended health care coverage. Please note that failure to pay for two consecutive assessment/therapy sessions will result in a suspension of therapy until your account is settled.

    Cancellation Policy

    We require at least 48 hours of notice for a cancellation of an appointment. Our policy is to charge full regular fees for missed appointments and cancellations made with less than 48 hours notice. You may leave a message at any time on our confidential voice mail or with our service coordinator at , or e-mail, to notify us of your need to cancel or change an appointment.

  • Additional Consent for Release of Information for Billing Verification

    I authorize North Durham Professional Counsellors to release billing verification information, as requested by an insurance company. This would involve confirming my treatment dates, time duration of sessions (eg. 60 minutes), and fees paid. Given that billing verification requests may be made several months after treatment has concluded, this consent is considered ongoing.