Intake Form

I understand that I am requesting counseling services from Direct Connection Services and that I can choose between telephone, virtual, or in-person sessions.

I understand that Direct Connection Services collects personal information about my health and well-being to better understand and support my holistic health.

I understand that Direct Connection Services follows strict safety protocols to keep my personal information confidential.

I understand that Direct Connection Services will provide receipts and copies of legal documentation for my records.

I understand that, with my permission, my counsellor at Direct Connection Services can discuss any of my challenges with members of other disciplines to better support me. This may include doctors, nurses, nutritionists, community care providers, spiritual advisers, lawyers, and alternative medicine practitioners.

Counseling sessions will remain confidential except in the following cases: 1. If there is abuse or risk of abuse, it must be reported to the authorities. 2. If there are concerns about self-harm or harm to others, it must be reported to the authorities 3. If required by a court subpoena or other legal request. 4. To receive professional or legal consultation regarding a case.

I understand that using electronic communication systems, despite their confidentiality, carries risks. I can choose to use voice calls or in-person sessions if I’m concerned about security.

I know my personal health information will remain secure and confidential, and any disclosure outside of my care will require my written consent, except for specific exceptions already explained.

I agree that this information was provided in clear, understandable language.

I understand that counseling may involve recalling unpleasant events and strong feelings, and outcomes cannot be guaranteed.

Intake & Consent

Therapy Fee Agreement

Cancellations

Counselling Informed Consent