Privacy and Sharing of Information

Nagham respects the privacy of her clients and holds in strict confidence all information regarding her clients and complies with applicable privacy legislation. No information will be released to a third party without your written permission. At any time, you have the right to withhold or withdraw consent, or place conditions on the disclosure of your information.

The nature of personal information collected may include: Information required to maintain a working file according to the standards of our profession and the Ontario College of Social Workers and Social Service Workers such as your name, address, phone numbers, date of birth, other contact information, names of others who are significant to your situation (family, your doctor, and other professionals) and sometimes their contact information. We also collect information about our work and the social workers actions in this regard, any correspondence sent or received, any consents or other documents you have signed, copies of papers you have given us and other documentation particular to the nature of our involvement. Information necessary for billing purposes which may include information about your Assistance Program and their standards, information about other third party payers, copies of all receipts given to you including copies of electronic payments, copies of invoices and billing records and information related to the scheduling of appointments with you.

We collect this information for the following reasons:

• To maintain a clinical file or working file that meets the standards of our profession and the Ontario College of Social Workers and Social Service Workers.
• To provide this service for you in a manner that ensures your safety.
• To maintain a high standard of professionalism in the provision of service.
• To assist in the process of billing for my services.
• To meet other legal and regulatory requirements.
• To maintain records pertaining to the operations of a business and to make these records available if requested. There will be times when we ask you if we may speak with others about you and your situation. There will be times when you will ask us to do this as well. On these occasions, we will always discuss this information-sharing with you and we will look at the benefits and consequences of speaking to others about your situation. We would then ask for your informed, written or electronic consent for me to share your information.

There may be occasions when we must share information about you or your situation without your written consent.

These situations are very exceptional but may include the following:

• If we have information about abuse or risk of abuse to a child then I must report this to the proper authority.
• If we have a concern about any risk that you may do harm to yourself or harm to another person then I must take action to ensure your safety or the safety of others.
• If I am required by law to release information such as receiving a subpoena to court.
• When disclosure is needed to receive professional or legal consultation.
• If we must defend myself against a complaint filed with the Ontario College of Social Workers and Social Service Workers or any other court action.

While these events are rare, we would like to help you become aware that these possibilities do exist. Our primary goal is to foster a safe space where you feel comfortable and able to explore and disclose personal concerns. If there are other limits of confidentiality in your situation, we will identify and discuss them with you before proceeding with your service.

When we work individually with children and adolescents we will attempt to keep parents informed of their child’s/adolescent’s progress and attempt to keep parents involved in the therapeutic process. However, in the case of older adolescents, they are afforded the right to privacy.

There are times where we may also share pertinent anonymous information about certain clients within the confidential context of supervision, for the purpose of providing the highest quality care in the benefit of the clients. However, all identifying information such as your name will remain confidential. There will be times when you will ask us to do this as well. On these occasions, we will always discuss this information-sharing with you and we will look at the benefits and consequences of speaking to others about your situation. We would then ask for your informed, written consent for me to share your information.

Cancellation Policy

Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the therapists’ day that could have been filled by another patient. As such, we require 24 hours notice for any cancellations or changes to your appointment. Patients who provide less than 24 hours notice, or miss their appointment, will be charged a 50% administrative cost as a cancellation fee

Telehealth Policy

I understand that the video conferencing technology will not be the same as an in-person session with a provider due to the fact that I will not be in the same room as my provider. I also understand that, in order to have the best results for this session, I should be in a quiet place with limited interruptions when I start the session.

I understand the potential risks to this technology, include interruptions, unauthorized access and technical difficulties. I understand that my provider or I can discontinue the video therapy session if it is felt that the videoconferencing connections are not adequate for the situation. Options will be given to me including transferring to an audio only session or phone call

I understand that this consent will last for the duration of the relationship with Nagham Azzam Counselling Services, including any additional video therapy sessions I may have; I can withdraw my consent for a video therapy session at any time, and Nagham Azzam Counselling Services will work with me to find a suitable alternative.

I understand that same confidentiality protections, limits to confidentiality, and rules around my records apply to a video therapy session as they would to an in-person session

I agree to work with my provider to come up with a safety plan, including identifying one or two emergency contacts, in the event of a crisis situation during our sessions.

I understand that my provider may decide to terminate video therapy services, if they deem it inappropriate for me to continue therapy through video sessions. Nagham Azzam Counselling Services will work with me to identify another provider for in-person care

Agreement to Fee

I hereby agree to pay all fees relating to services received by Nagham Azzam Counselling Services as well as any third party collection and legal costs associated with any recovery of amount outstanding should they occur. I acknowledge that my session fee is $120.00 per one hour of face-to-face or virtual therapy session (excluding compliment consultation and scheduling) unless covered or otherwise specified through EAP or other contractual agreements in place. Other billable services, such as report writing, professional letters, form completion, and review of written records from other specialists are billed at the same rate.