Our sessions are strictly confidential, and any information that you give me will not be released to any office or individual without your written permission. There are a few exceptions regarding confidentiality that you should be aware. Please discuss any concerns you have about them with me.

1. If you are under the age of 19 and disclose abuse (sexual and/or physical) by a specific person, the abuse must be reported to the Ministry of Children and Family Development.
2. If you are over the age of 19 and disclose (sexual and/or physical) by a specific person who has access to person(s) under the age of 19, the abuse must be reported to the Ministry of Children and Family Development.
3. If there is a serious possibility that you may harm yourself or others, I must take reasonable action, which may include contacting the police or other responsible authorities.
4. If you are impaired by drugs and/or alcohol and intend to drive, I must report this to the Motor Vehicle Branch and/or police.
5. In some court actions, I and my records maybe subpoenaed. This is not a frequent occurrence: however, you should be aware of the possibility.

Counselling with Family Members
In some circumstances, I work with more than one family member and can see each individually or in a group. If you or a family member is seen separately, I believe in the rights of all family members to privacy in their communication with me. I ask family members to respect the boundaries of privacy and confidentiality whether they are children, siblings, partners or parents, with each person’s right to choose when and with whom they share information.

Therapist’s Supervision, Case Management, and Information Sharing
In order to provide the best possible service, I may seek consultation with other professionals. In discussing a case under these circumstances, I do not reveal any identifying information about the client.

By checking the box, I agree that I have read and understand the above information.

Counsellors Signature: Sheran Selluski, MA