I have read and understand the statement of confidentiality below as well as the limitations.(Required)

Confidentiality is very important for the integrity of the counseling relationship. Counselling services for children, youth, adults and families are kept confidential which means that no information will be disclosed without the informed, voluntary and written permission of the client and/or parent/guardians accept for the following circumstances:

1) if a child is or may be at risk of abuse or neglect, or is in need of protection
2) if the counsellor believes that you or another person is at clear risk of imminent harm;
3) if a counsellors records have been subpoenaed by the courts, or if the disclosure is otherwise required or authorized by law.

Every reasonable effort will be made to discuss these circumstances with you prior to the involvement of other professionals.

Fees and Cancellation Policy

I have read and understand the stated fees and cancellation policy below.(Required)

Fee’s and Cancellation Policy

Currently my office hours are Mondays and Tuesdays from 2:00pm to 7:30pm. I have two options for service which will be discussed with the client or parent/guardian prior to beginning services to determine which will be appropriate for you and/or your child. The two options are as follows:

1) 1 hour session for $120 2) 45 minute session for $100

Payment can be made via cash, cheque or etransfer ( If you are unable to make it to your scheduled appointment, 24 hours notice is required to avoid being charged. Please contact Amy @ 604-614-2537 if you are running late. Clients who fail to show up to their appointments without 24hour notice will be charged the full amount for the session.

Guardian's information

[1] Guardian's name(Required)

Signatures of Parent/guardian(s):

This field is for validation purposes and should be left unchanged.