Fields & Flour Therapy strives to create an environment which supports you through your gained awareness and change. We hope to provide you the tools and understanding so you may consciously experience yourself authentically and become aware of your needs. 

 

Part of beginning this therapeutic relationship requires the opportunity to understand and make an informed choice to consent in service (or Informed Consent). As such, the details are described below, so you can make an informed choice to participate in service. 

 

CANCELLATION POLICY, APPOINTMENTS AND FEES

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 $85.00 cancellation fee. 

 

APPOINTMENTS

Appointments will be made determined by you and your therapist.  You agree to understand that you must book appointments online (or by phone) and that appointments will be based on availability.

PAYMENT OF SERVICE

Payment of service will be requested at the time of your appointment, unless otherwise stated. Payments can be made by cash, cheque, e-transfer or credit card. Any cheques returned due to insufficient funds may result in a charge of $60.00, plus bank charges.

SESSION FEES

Individual Online $165 (50 minutes), Individual In-Person, Nature Sessions, Baking Sessions $165 (50 minutes) 

 

CONSENT TO TREATMENT

Fields & Flour Therapy, welcomes you as a potential client. We believe it is important for you to be informed about services and rights which govern our commitment to supporting you in your experience. As a client, you have rights. We are committed to treating each person with respect, dignity, consideration and adhering to a code of ethics which supports a client-centred approach, regardless of race, gender, age, religion or beliefs. 

 

CLIENTS UNDER THE AGE OF 18

Parents or Guardians who are consenting to have their child under the age of 18 participate in counselling service understand that under the Child, Youth and Family Services Act, 2017, S.O. 2017, c.14, Sched. 1., states:

 

"Treatment, such as counselling, medication, or psychotherapy, cannot be provided to a young person without consent. If the young person is capable, they can decide if they want to give or refuse consent to treatment. In other words, as long as a young person understands the treatment, why it’s being recommended, and what will happen if they accept or refuse treatment, the health care provider and family must respect the young person’s decision."

• There is no general age of consent to treatment or counselling; instead, the issue depends on whether the young person is capable of consenting. A young person will be found to have capacity to consent or to refuse consent if they both: understand the information relevant to the proposed treatment in issue, and appreciate the reasonably foreseeable consequences of consenting or refusing consent.

• For obvious reasons, a baby or young child does not have capacity to consent. As a child gets older, however, the issue becomes more complicated. It is up to the person proposing the treatment to decide if the young person or child is capable of consenting or refusing consent. The issue of capacity requires the practitioner to consider the child’s age, maturity and general level of understanding. An individual’s capacity may also vary over time. A young person may be capable of making certain decisions but not others.

 

DOCUMENTATION AND LIMITS OF CONFIDENTIALITY

With current standards and guidelines of care governed under the Ontario College of Social Workers and Social Service Workers. Your therapist keeps records of your counselling/psychotherapy. We are legally and ethically bound to maintain confidentiality. Your personal information will not be disclosed unless you specifically direct me to communicate with other persons or organizations, or when required by law. The following are examples in which confidentiality may not be maintained:

1. We believe a client may be a danger to him/herself or others 

2. There is a reasonable suspicion of actual or potential child neglect or abuse (physical, emotional, sexual) by the client or others known by the client

3. There is reasonable suspicion of neglect or abuse of a dependent adult or elderly person 

4. A client is “gravely disabled” (unable to take care of basic needs)

5. There is a valid court order to disclose

 

BENEFITS AND RISKS OF COUNSELLING/PSYCHOTHERAPY 

Counselling/psychotherapy can help a person to gain new understanding about his or her difficulties and to learn new ways of coping with and solving issues, such as anxiety, anger, depression, parenting or relationship concerns. Counselling/psychotherapy can help a person to develop new skills and to change behaviour patterns. Counselling/psychotherapy can contribute to improved ability to cope with stress and difficult situations and can increase understanding of self and others.

By signing this consent, you acknowledge that your counsellor has advised that while there are potential benefits to counselling, there is no guarantee of success and that there are potential risks.

Please be advised that during counselling/psychotherapy, emotions and memories may be stimulated which can evoke strong feelings and that changes in awareness may alter my self-perceptions and ways of relating to others. 

You have been advised that the process of personal change can be quite varied and individual. You understand that it is important that you mention promptly any concerns or questions that you may have at any time during the process of counselling/psychotherapy to your therapist, or the Lead Therapist/Owner Courtney Fuciarelli. 

 

COMMUNICATION 

Communication to book appointments may occur via text, email or phone. Therapeutic services are in person only, phone or virtual. In urgent and emergency situations you may access crisis support provided to you by your counsellor/psychotherapist, or may call 911.

 

ONLINE COUNSELLING

Counselling services which are online in nature are most suitable for clients over the age of 18 years-old who have either previously engaged in formal counseling services, and/or are seeking short-term support for issues that are unrelated to major crisis, severe mental health issues, suicidal, homicidal or violent behavior (past and present). If you have any history of major psychiatric episodes, hospitalizations or drug/alcohol dependence or have been diagnosed as any of the following – Borderline Personality Disorder, Major Depressive Disorder, Bipolar Disorder Type 1, Mentally Ill/Chemically Addicted (MICA), and/or Schizophrenia – you must disclose this information to Fields and Flour Therapy, prior to being considered for online counseling services. Failure to do so or knowingly misleading or withholding the above said information excludes Fields and Flour Therapy from any liability related to said client’s diagnosis, prognosis, outcome and actions.

If it is deemed at any point in the treatment that your needs are greater than Fields and Flour Therapy counsellor’s area of expertise or scope of practice and a client is unsuitable for online counseling services, we reserve the right to refuse and/or end treatment and appropriate referral sources will be provided. The disadvantages of online counselling includes communication barriers and lack of body language assessment and privacy, as well as potential technological issues which may impact the delivery of services. Clients may provide off-line contact information in case of a technology breakdown.

Virtual/Phone Session Consent:

1. I understand that I am about to engage in a video therapy session with my provider, Fields & Flour Therapy.

2. 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.

3. I understand the potential risks to this technology, including 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.

4. My provider agrees to inform me and obtain my consent if another person is present during the consultation, for any reason. I agree to inform my provider if there is another person present during the session or if I wish to tape the session.

5. I understand that there are alternatives to a video therapy session available, including the option of finding another Psychotherapist to see in-person if available in my area.

6. I understand that I can direct questions about this video therapy session at any time to my provider.

7. I understand that this consent will last for the duration of the relationship with my provider, including any additional video therapy sessions I may have; I can withdraw my consent for a video therapy session at any time, and Fields & Flour Therapy will work with me to find a suitable alternative.

8. 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.

9. I agree to work with my provider to come up with a safety plan, including identifying an emergency contact, in the event of a crisis situation during our sessions.

10. 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. My provider will work with me to identify another provider for in-person care.

 

GENERAL RISKS FOR COUNSELLING SERVICE

Clients of Fields & Flour Therapy have the right to be informed of potential risks and benefits of counselling/psychotherapy. At any time you may request information regarding counselling/psychotherapy process/techniques used. If at any time you are uncomfortable or dissatisfied, you have the right to discuss your counselling/psychotherapy with anyone you choose (including another counsellor/social worker/psychotherapist), or terminate your counselling/psychotherapy at any time. Should we not be qualified to support you in your needs or feel you could be better assisted, you will be informed of this and a referral to appropriate services will be made. It is essential your wellness and care be our centred focus.

 

 PSYCHOTHERAPY/COUNSELLING RISKS

There may be both benefits and risks while participating in counselling, long distance or otherwise. Counselling may improve your ability to relate with others, provide a clearer understanding of yourself, your values, and your goals. Since counselling may also involve discussing unpleasant aspects of your life, you may also experience uncomfortable feelings. Counselling often leads to better relationships, solutions to specific problems, and significant improvement in feelings of distress. Also, please understand there are no guarantees of what you will experience, and that you enter this Agreement and use Fields and Flour Therapy at your own risk. You agree that you understand the possible advantages and disadvantages of therapy and shall not hold your individual counsellor, nor Courtney Fuciarelli, R.S.W, nor Fields and Flour Therapy accountable for any information or insight distributed here.

 

NATURE THERAPY RISKS

By participating in nature "walk and talk sessions", you assume any responsibility for the possible physical injury which may occur in those settings. Fields and Flour Therapy does not assume responsibility for any injury, sustained or otherwise, nor any loss and/or damage caused as a result of the activity.

 

THERAPEUTIC BAKING RISKS

By participating in baking therapy, you assume any responsibility for the possible physical injury and material loss which may occur in the event of an accident, fire or other result of misadventure while engaging in cooking and baking in your kitchen. This may be related to accidental physical injury, food poisoning, consumption of material which causes an allergic reaction, and so forth. Fields and Flour Therapy does not assume responsibility for any injury, sustained or otherwise, nor any loss and/or damage caused as a result of the baking activity suggested in sessions or in the Group Programs or Self-Study Modules.

 

DISCONTINUING THERAPY

Either party may terminate the relationship at any time with 24 hours notice. Less than 24 hours notice from the client incurs a session fee. The client does not need to provide a reason. The therapist may terminate and refer if there is a clincal reason, or a breech in contract, or if they are not reasonably able to maintain session provision. The therapist may decline to take a client on without providing a reason.

 

If it becomes inappropriate to continue treating a client for clincal, safety, non-cooperation, inappropriate communication, supervisor's discretion, or non-payment reasons, including if the client has not revealed pertinent facts about their condition from the outset that effect appropriateness of ongoing treatment, or failed to engage in the process through attendance or otherwise, the client will be discharged with referral to the appropriate service. Interpersonal relationship between the therapist and client is important to the therapy process, and when clearly this is not positive, it is also appropriate to refer.

 

GENERAL ISSUES REGARDING ATTENDANCE AND COMMUNICATION:

If at any stage during your therapy suicidal feelings exist, you must tell your therapist even if you feel your feelings are not life threatening. Our goal is to help you build a relationship with these feelings.

Repeated cancellations (3 in a row) will result in revoking access to the booking portal.

 

Letter/report requests for any reason will result in a $75.00 fee. This fee covers that time we spend writing reports. Letters/reports will not be forwarded until seen by you. You must also sign a release of information form in order for letters to be released.

Fees will be increased by $5.00 to $15.00, at the discretion of Fields & Flour Therapy. Data is kept in a secure platform called Practice Better (Canadian server and data) and your information is kept for period of 10 years as per the Psychotherapy Act, 2007, S.O. 2007, c.10, Sched. R.