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The following document will be discussed
during the initial session; please take the time to review it and note any questions or concerns you may have, so we may properly address them.



Welcome to my practice. 


In this document I will provide you with some information about my professional qualifications and approach to treatment. I will inform you about the benefits and risks of psychotherapy, client rights and responsibilities, confidentiality and payment policies, so that you may make an informed decision about your participation. I would be glad to answer any questions or concerns you may have. 


Psychotherapy is intended to help individuals and couples improve their sense of well-being and resolve issues and concerns adversely affecting the quality of their lives. This primarily talk-based therapy has been shown to have benefits for individuals who go through it, as it could lead to better relationships, solutions to specific problems, significant reductions in feelings of distress, improved self-esteem and overall enhanced sense of functioning. It is important to note that psychotherapy is a personal exploration and there are no guarantees of what you may or may not experience. Your outcomes are largely related to your efforts and participation. Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of one’s life, it is not unusual to experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness. If this occurs, please make sure to talk to me, so I could adequately support you. Together, you and I will work to achieve the best possible results for you. I believe that clients have the capacity and resilience to resolve their own problems and make their own decisions; however, from time to time all of us need assistance, support and direction and I will work with you to establish goals and map out steps for your therapy. 

I am trained and experienced in the application of evidence-based psycho-social interventions for individuals and couples struggling with relationship issues, depression, stress, anxiety and post-traumatic stress. As a counsellor I have supported clients from diverse populations in various ways - from alleviating everyday stress and anxiety to managing mood, behavior and personality disorders. To meet the clients' individual needs, I use an integrative approach, drawing from therapeutic models such as Cognitive-Behavioural Therapy (CBT), Psychodynamic Therapies, Developmental Model of Couples Therapy, Emotionally Focused Couples Therapy, Dialectical Behavioural Therapy, Motivational Interviewing and Trauma-Informed Treatment Methods. 




As your counsellor, I am committed to protecting your right to confidentiality; this means that the information you share during our counselling sessions will not be revealed to any other agency, without your written permission or request. To ensure quality of service and as part of my commitment to professional development, I engage in regular clinical supervision. 

Consent for supervision: In the event that Your Therapist requires supervision by Dr. Bita, clinical psychologist, CPO#5333, for training purposes, You consent for Your Therapist to be supervised by Dr. Bita (which involves some degree of disclosure). You understand that you can request a meeting with Dr Bita, if You wish to do so she can be reached at You understand that information shared with Your Therapist including, but not limited to, formal psychological reports, evaluations, assessments, tests shall remain confidential and will not be disclosed to anyone, except if needed with Dr. Bita, without Your explicit written consent, unless one of the following situations arise: risk of harm to You, Your Child, or any other individual, subpoena/court order, demanding disclosure, evidence that the security or development of a child (or vulnerable adult) has been abused or is in danger of abuse. 


I would like you to understand that there are certain situations in which I may be legally required to reveal the information obtained during counselling to a third party without your consent. 


Limits to confidentiality apply in circumstances under which: 

  • You give me reason to suspect that a child may need protection, (i.e. child abuse or neglect). There is a legal obligation to inform the Children’s Aid Society if a client is placing a child at risk for sexual or physical abuse. 
  • When I recognize that you may pose danger to yourself and/or others, i.e. expression of suicidal ideas, non-disclosure, exposure and transmission of infectious disease, planning to carry out activities that may violate and endanger the lives, health and security of others. 
  • If counselling records are ordered to be produced by a court of law. 
  • If I must use information from your counselling record to defend myself in a professional liability lawsuit filed by you. 
  • If the client is a health professional who is abusing or has sexually abused a client/patient, this must be reported to his or her regulatory body. 
  • In case of medical, psychiatric or psychological emergency, I will contact your emergency contact, as identified by you, and/or the appropriate emergency response services. 
Confidentiality and shared records: 
When an individual participates in group, family, or couple therapy and requests access to the record, I can only provide information relating to the individual who filed the request, unless other participants have provided their consent. 



Counselling Relationship: It is helpful to remember that our relationship is professional and not social. Our professional relationship is of utmost importance as we work together towards achieving your goals and bringing resolution and healing to your life. 


Client Rights and Responsibilities: 

  • You are responsible for coming to your session on time and not being under the influence of drugs or alcohol. 
  • You are responsible for paying the fees agreed upon. 
  • You have a right to participate in developing an individual plan of treatment. 
  • Every client in psychotherapy should have a treatment plan that describes general goals of therapy, and specific objectives the client will work on, to achieve their goals. 
  • You have a right to receive an explanation of services in accordance with the treatment plan. 
  • You have a right to participate voluntarily in and to consent to treatment. 
  • You have a right to be treated in a manner which is ethical and free from abuse, discrimination, mistreatment, and/or exploitation. 
  • You have a right to object to, or terminate, treatment. 
  • You are in complete control and may end the counselling relationship at any time, though I do ask that you participate in a termination session. 
  • If you are dissatisfied with my services, please let me know. If I am not able to resolve your concerns, you may contact the College of Registered Psychotherapists of Ontario to file a complaint. 



Consultation and therapy visits last approximately 50 minutes to one hour and are offered by telephone, video or in-person. 

Cancellations must be made with at least 24 hours notice, or charges for the missed session will be made, in full.

  • Fees for Telephone, Video or In-Person Services: Counselling/Psychotherapy Session (Individual or Couples) …………………………………… $ 188 (includes HST) 
  • Special services such as written reports, treatment updates and letters are billed at the hourly rate. 


Fees are due at the time of service. Payment can be made by e-transfer, or credit card. Online Credit Card payments are processed by Stripe. E-transfer requests may be used for accounts that are overdue. If no payment is made against an account and no arrangements for payment have been made, therapy will be discontinued, and the debt will be put into collection. This action is an absolute last resort and not taken lightly. If you have extended health care insurance, you may be able to get reimbursed for some or all the fees, depending on your plan. Please confirm your insurance coverage and limitations for services provided by a Registered Psychotherapist with your insurance provider.



Sometimes clients have an emotional emergency, which requires immediate attention. Lakeridge Counselling & Consulting Services is not a crisis center and it does not provide crisis or emergency services. You are encouraged to call or email the office with the understanding that your call will be returned as soon as possible, within the next 24 business hours and you could expect to be given an appointment within 24 to 48 business hours. If you feel that you cannot wait, or it is the middle of the night or during the weekend, you are encouraged to contact your family physician, call Crisis Services Canada at  988, call  911, or go to the Emergency Department of any hospital.  


Lakeridge Counselling & Consulting Services is not a crisis centre and it does not provide crisis or emergency services. Counselling and Psychotherapy at Lakeridge Counselling & Consulting Services are accessible by appointment only and depending on availability. 

If you are experiencing an emotional crisis (intense feelings of distress), emergency, life threatening situation, or any other type of crisis, please Call 911 or go to the nearest hospital.

Call a trusted friend or relative... …ask them to talk with you or come over right away.

You can reach Crisis Services Canada at  1.833.456.4566