Informed Consent

Nature of Services: I understand that I will be receiving counselling services from Arian Abyaneh (Ari) at Ari’s Therapy. Counselling may involve discussing difficult or uncomfortable topics related to my personal experiences, relationships, emotions, thoughts, behaviors, etc. in order to work towards agreed upon goals.

Risks and Benefits: Potential benefits include improved relationships, solutions to specific issues, greater self-awareness and understanding. Potential risks include experiencing uncomfortable feelings like sadness, guilt, anger, or anxiety when discussing difficult aspects of my life. However, counselling has been shown to have benefits that outweigh the risks for most people.

Confidentiality: All information disclosed within sessions is confidential and will not be revealed to anyone without written permission, except where disclosure is permitted or required by law (e.g. suspected child abuse, potential harm to self or others, court order, etc.).

Rights: I understand I have the right to ask questions about the counselling process, techniques used, credentials of my counsellor, and other relevant information at any time. I have the right to end counselling at my discretion.

Consent: I voluntarily agree to receive counselling services and understand I can withdraw consent at any time. I will work collaboratively with my counsellor to establish goals and treatment plans.

Payment Information: I understand and agree to the following payment terms:

  • Payment is due after each counselling session. 60 minute sessions are billed at $160 per session and 90 minute sessions are billed at $240 per session.
  • An invoice will be emailed to me on the same day following the session.
  • The accepted method of payment is e-transfer. Payments should be sent to ari@aristherapy.ca
  • I agree to submit payment within 24 hours of receiving the invoice.
  • If I need to make alternative payment arrangements, I will discuss this with my counsellor in advance.
  • A 24-hour cancellation policy is in effect. Missed sessions may be billed at 100% of the session rate.

Online Counselling Sessions: I understand that counselling services are provided online through video conferencing platforms. By consenting to online sessions, I acknowledge and agree to the following:

  • Technology Requirements: I require a computer and internet connection for online sessions. This includes a device with a camera and microphone, and a stable internet connection.
  • Privacy and Confidentiality: While the counsellor will take all reasonable precautions to protect my privacy, I understand that online communications are never 100% secure. There is a potential risk of unauthorized access or technical difficulties that may compromise confidentiality.
  • Session Environment: I agree to participate in online sessions from a private, quiet location where I will not be overheard or interrupted. I will not record the session without prior agreement from the counsellor.
  • Technical Difficulties: If technical issues arise during a session, we will attempt to reconnect. If reconnection is not possible, we will reschedule or continue by phone if appropriate.
  • Emergency Situations: I understand that online counselling may not be suitable for emergency situations. In case of an emergency, I agree to contact local emergency services or go to the nearest emergency room.
  • Data Storage: Session notes and other relevant information will be stored securely in accordance with privacy laws and professional standards.

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Consent Form Completed.

*IMPORTANT* You have completed the Informed Consent Form. Please continue by filling out the Intake Form below, and make sure to submit that form as well at the bottom of the page when you are finished. Thank You!

By signing your name in the field below, you acknowledge that you have reviewed and fully understand the terms and conditions above.

Intake Form

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You Have Completed All Required Forms

Thank you for completing the Informed Consent and Intake Forms. Ari will be in touch with you shortly with the next steps. If you have any further questions you can email Ari at ari@aristherapy.ca
Are you looking for on-going support or do you have a specific problem you’d like to address? (You can choose both if they both apply to you)
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