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Freedom & Hope Counselling & Therapeutic Services
Client Service Agreement
- Read, check, and sign where applicable;
all boxes with an * are required.
Please read the entire document carefully. If you have any questions, concerns, or reservations about any section, do not sign or submit the form. Instead, discuss your concerns directly with your therapist. If your therapist is unable to address your concerns to your satisfaction, FHCTS may not be the right fit for you—and that is perfectly okay. By signing this agreement, you acknowledge that you have read, understood, and agree to all sections in full.
Confidentiality, Limits, Supervision, Emergencies
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Confidentiality
All information shared, documented, and recorded (by Daniel) during counselling sessions will remain confidential in accordance with the ethical standards and guidelines established by his regulatory Colleges. When clinically appropriate, consultation may occur between your therapist and other qualified professionals who are bound by confidentiality agreements to ensure optimal treatment outcomes.
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Limits to Confidentiality
Confidentiality is maintained except in the following legally and ethically mandated circumstances:
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When disclosure is required to prevent clear and imminent danger to the client or identifiable others
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When legal requirements mandate that confidential information be revealed (e.g., court orders, subpoenas)
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When there is reasonable suspicion that a child is in need of protection
Supervision
With Daniel, all session recordings and transcriptions are accessible under the clinical supervision of Dr. Randy Johnson, PhD, who provides supervision for him with the College of Alberta Psychologists.
Emergency Care
We are not an emergency service. If you are in crisis, call 911 or your local crisis line.
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Recording, Documentation, Client Access, AI Consent
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Client Recording Policy
Clients may not audio or video record sessions without prior written permission from their therapist. This restriction does not limit your right to discuss the content of your counseling sessions with others. Beyond the exceptions outlined in this agreement, you maintain full discretion regarding what information from your sessions you choose to share.
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Session Recording and Documentation
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In‑person sessions are audio recorded and transcribed (no video). Virtual sessions are audio and video recorded by default and transcribed. While we use strong security measures, online sessions cannot be guaranteed to be absolutely secure at all times, and there is always a small risk of a breach. We will do everything possible to keep your information safe while it is being processed and stored.​​​
Data Security
Our system fully adheres to the Personal Information Protection and Electronic Documents Act (PIPEDA) standards. All data remains strictly under our control, is never bought or sold, and is not shared with any third party.
Storage Location
Freedom & Hope Counselling & Therapeutic Services uses Microsoft 365 programs for documentation and communication and Microsoft stores your files, recordings, and related data at rest in Canadian Microsoft datacenters under Microsoft’s data residency commitments.
Client Access to Recordings
Clients may request access to their session recordings for personal use at any time. Once you receive the cloud storage link to access your recordings, we cannot monitor or control subsequent access. You assume full responsibility for the security and confidentiality of any recordings you request and access.
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AI‑Assisted Care (Consent Required)
We use artificial intelligence (AI) to assist with session summaries, testing and assessments, and report generation. Your therapist reviews and perfects ALL work done by AI. AI is like an assistant, not a replacement for your therapist.
All work is done through licensed Microsoft Business applications, restricted by business agreements that no data will be exported, used, stored, or sold outside Freedom & Hope Counselling & Therapeutic Services’ direct control. All data is maintained and held in Microsoft systems.
We use strong security measures (e.g., encryption and access controls) to protect your information.
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​If you require that the video recording of your virtual sessions not be save but deleted after their creation, type "Yes" in the box below:
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I agree with the use of AI as defined above:
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Teletherapy, Security, Breach Notice, Communication Privacy
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Teletherapy
Virtual sessions are conducted via Microsoft Teams using unique meeting IDs and passcodes for each session. All systems are protected by Microsoft security software. We also use strong security measures such as encryption and access controls; however, all online communication carries some risk despite security measures.
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Breach Notification
In the event of any suspected breach of confidentiality, your therapist will immediately assess the situation in consultation with relevant professionals and notify all affected parties, including clients and professional regulatory bodies.
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Communication Privacy
Contact information will not be shared with third parties or affiliates for marketing or promotional purposes.
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Email Security: Email is convenient but not fully secure. While we take precautions, email communication may carry some risk of unauthorized access. Please avoid sending highly sensitive information by email.
​​Fees, Payments, Booking, Cancellations/Rescheduling,
Receipts, Session Length, Insurance
Session Fees
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Individual sessions
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With Mia: 50 minutes at $150.00 per session
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With Daniel: 50 minutes at $240.00 per session
Couples and Family sessions
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With Mia: 90 minutes at $225.00 per session
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With Daniel: 90 minutes at $360.00 per session
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Booking Process
To schedule an appointment, please contact your therapist of choice through the “Contact Me” tab in our menu. When requesting an appointment, please provide three date and time ranges when you are available to meet. Your therapist will respond with a confirmed booking using one of your proposed options.
For first‑time clients, your therapist will provide:
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Pre‑session information and intake requirements
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Directions to the clinic office (for in‑person sessions)
Payment Methods
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Credit Card or Direct Billing
Complete the Payment Information form located in Site Directory > Quick Access > Forms and submit it. If you have Blue Cross coverage, please include your policy details at the bottom of the form. Payment will be processed on the morning of your scheduled session.
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E‑Transfer
If you do not have a credit card or Blue Cross, you may pay by e‑transfer. Send payment to your therapist’s email address at least 48 hours before your session. Sessions will be cancelled if payment is not received at least 24 hours prior to the appointment time.
Cancellation and Rescheduling Policy
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Cancellations made more than 48 hours before the scheduled session are fully refundable.
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Rescheduling requests 24–48 hours before the session incur no additional cost.
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Same‑day rescheduling may be accommodated based on availability. Please email or text as early as possible. If alternate arrangements cannot be made, your session will proceed as scheduled regardless of attendance.
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Cancellations within 24 hours or no‑shows will be charged the full session fee, except in exceptional circumstances.
Receipts
Receipts are sent out at the time of receiving payment through the credit card, or, if fees are received by e‑transfer, they are typically sent that day or the next business day.
Session Structure and Duration (Billing Overages)
Standard individual sessions are scheduled for one hour but consist of 50 minutes of clinical contact time. The remaining time is used for clinical documentation and preparation for subsequent sessions. Occasionally, sessions may extend beyond 50 minutes, especially when more time is needed for emotional stabilization. When this occurs, you will be notified of the additional fee (calculated at your current session rate, prorated in 15‑minute increments) which will be taken from your credit card, or you will receive an invoice that is expected to be paid within 24 hours of session completion.
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Insurance Coverage
Mia is a Master Practicing Clinical Counsellor (CPCA #3875), and a Counselling Therapist (ACTA #2438).
Daniel is a Registered Provisional Psychologist (CAP #P7619) and a Registered Clinical Counsellor (BCACC #19147).
Please verify your coverage with your insurer before your first session.
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Data Retention, Jurisdiction, Final Declaration
​Data Retention
We keep clinical records for 10 years after your last contact. For minors, records are kept 10 years after the age of majority.
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Storage Location
Microsoft stores your records at rest in Canadian Microsoft datacenters under Microsoft’s data residency commitments.
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Jurisdiction and Venue
This agreement is governed by the laws of the province where you reside. Any disputes will be handled in that province.
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Final Declaration
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By submitting this form, I confirm that I fully agree with the terms and conditions of this Client Service Agreement in full. I affirm that I am the person identified in this form and that I am seeking a working alliance with Freedom & Hope Counselling & Therapeutic Services. This agreement will remain in effect as long as I am a client with them.
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