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
Confidentiality
All information shared, documented, and [recorded (specifically - Daniel)] during counselling sessions will remain confidential in accordance with the ethical standards and guidelines established by each therapist's respective 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.
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
Specifically 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
Freedom & Hope Counselling & Therapeutic Services is not an emergency service. If you are in crisis or require immediate assistance, call 911 or your local crisis line.
Recording, Documentation, Client Access, AI Consent
Client Recording Policy
Clients may not record sessions in any manner without prior written permission from their therapist. This restriction does not limit a client’s right to discuss the content of counselling sessions with others at their discretion.
Session Recording and Documentation
Specifically with Daniel, in‑person sessions are audio recorded and transcribed without video. Virtual sessions are audio and video recorded by default and transcribed. While strong security measures are used, online communications and recordings can never be guaranteed to be absolutely secure, and there is always a small risk of breach. Reasonable efforts are made to protect information during processing and storage.
Data Storage and Cross‑Border Processing
Freedom & Hope Counselling & Therapeutic Services uses Microsoft 365 programs for documentation and communication. Client files, recordings, and related data are stored at rest in Canadian Microsoft datacenters under Microsoft’s data residency commitments. In limited circumstances, service providers may process information outside of Canada, including in the United States, for purposes such as secure transmission, system support, or system reliability. Reasonable safeguards are applied, and only the minimum necessary information is processed.
Client Access to Recordings
Clients may request access to their session recordings for personal use. Once access is granted through a secure link, Freedom & Hope Counselling & Therapeutic Services cannot monitor or control subsequent access. Clients assume responsibility for the security and confidentiality of recordings they request.
Specifically with Daniel, AI‑Assisted Care
AI‑assisted tools are used within licensed Microsoft business environments to support documentation, session summaries, assessments, and report preparation. All AI‑assisted work is reviewed by the therapist. Client information is not used to train public AI models. Access to these tools is restricted, monitored, and designed to minimize identifiable information.
If you do not want your session to be video recorded please state that in the box below:
If you DO NOT agree with the use of AI as defined above, state that in the box below:
Teletherapy, Security, Breach Notice, Communication Privacy
Teletherapy
Virtual sessions are conducted via Zoom with Mia, and Microsoft Teams with Daniel, using unique meeting IDs and passcodes. Systems are protected by security software, encryption, and access controls. Despite safeguards, all online communication carries some risk of unauthorized access.
Breach Notification
In the event of a suspected breach of confidentiality, the situation will be promptly assessed in consultation with relevant professionals, and affected clients and regulatory bodies will be notified when required.
Communication Privacy
Client contact information is not shared with third parties or affiliates for marketing or promotional purposes. Email is convenient but not fully secure. Clients are advised to avoid sending highly sensitive information by email.
Fees, Payments, Booking, Cancellations/Rescheduling,
Receipts, Session Length, Insurance
Session Fees
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
Booking Process
Appointments are scheduled through contact with the therapist. Payment is processed using credit card, direct billing where applicable, or e‑transfer according to provided instructions.
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
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.
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
Cancellations made more than 48 hours before a scheduled session are fully refundable. Rescheduling requests made 24–48 hours prior incur no additional fee. Cancellations within 24 hours or missed appointments are charged the full session fee, except in exceptional circumstances.
Receipts and Insurance
Receipts are provided following payment. Clients are responsible for verifying insurance coverage prior to sessions.
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.
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.
Data Retention, Jurisdiction, Final Declaration
Data Retention
Clinical records are retained for 10 years following the last client contact. Records for minors are retained for 10 years following the age of majority.
Jurisdiction and Governing Law
This agreement is governed by the laws of the Province of Alberta and applicable federal law. Nothing in this agreement limits the application of mandatory professional, privacy, or consumer‑protection laws in the province or territory where the client ordinarily resides. Any disputes will be handled in Canada by a court of competent jurisdiction.
Final Declaration
By signing or submitting this agreement, you confirm that you have read and understood its contents and agree to be bound by its terms. This agreement remains in effect for the duration of your therapeutic relationship with Freedom & Hope Counselling & Therapeutic Services.
