Forms

Please know that since the pandemic, there have been changes to how sessions are provided and how forms are submitted.

Sessions are now provided both online and in-person.  Consent and information forms are generally required to be submitted online, through an encrypted email address that I will provide when we set up our first appointment. You can reach me there with an encrypted email at cortney@ontariotherapist.com. Forms can be downloaded and either printed from my website, and then submitted as jpegs or scanned documents, or can be downloaded and completed as Word or PDF documents which can then be returned as such.

If your technology is limited, and we are conducting an in-person session, I ask that you please let me know in advance so I can provide the paperwork to you when you arrive. In that case, I will ask that you arrive about 20 minutes early to complete everything in the waiting room. Please know I cannot accept forms by mail or any third party.

Please note there have been changes made to the consent forms below as of March 2020 regarding privacy and security, and communication, as well as to sessions during an illness.

Please note that the Consent for Release of Information form is generally only needed once or if we decide to bring others into therapy — such as family doctors, family members, and so on – this is your Circle of Care.  It is advisable to complete this form in the case of couples and family counselling.  I will at that time, have you become more specific.

The Walking Talking Consent Form may not be applicable.  If you think you might like to try it at some point, it could be helpful to complete it in advance.

Please know my request for gender pronouns in one of my forms, is to help me use the most respectful language when serving you. You are under no obligation to complete that part of the form.

The first 3 forms are required by all new clients:

Informed Consent Form

Counselling Website Intake and First Session Orientation Form

Telephone, Online Consent Form

The Consent to Release and Share information is situation specific and is not needed by every client for every circumstance. Please ask if unclear.

Consent for Release of Information

Walk and Talk is for those interested in doing this activity during therapy sessions. Please ask if unclear.

Walking Talking Consent Form

Couples Intake Form is for Couples only.  Please ask if unclear.

Couples Intake Questionnaire

EMDR Consent Form is for those who are consenting to receive EMDR treatment specifically.  Please ask if unclear.

EMDR Consent Form

Please know clients may also be asked to complete additional forms related to anxiety, depression, dissociation and trauma history.

 

Email: cortney@ontariotherapist.com

Conveniently located office: Online across Ontario

and in person:

287 Main Street West, Hamilton, Ontario (In-between Queen and Locke Streets). Free parking in the back of the building or metred parking across the street. Entrance in the front.  Waiting room through the front door to the right.  Please note that I operate a scent-free office to protect people with allergies and sensitivities, and will ask all clients to remove their outer footwear before entering the office.  I require 48 hours for cancellations to avoid a fee, and I accept cash, visa and interac e-transfer for payment at the time of the appointment.  I require clients to provide credit card information in the case that payment is not made within 48 hours through other means.

I also offer services online and over the phone.