COUNSELLING
INTAKE FORM & AGREEMENTS

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Please, fill out the forms below

Privacy Agreement

Through the therapeutic process, confidentiality is maintained for the participant.

You instruct Maria Antonieta Dubuc to tell somebody else to provide written permission in the following circumstances:

  1. You are a risk of harm (e.g: self-harm or suicide)or there is harm to others.
  2. The student is ordered by a court to disclose information.
  3. The participant is going to break the law.
  4. Abuse of children is a mandatory reporting office that the student is bound by law to report.

For supervision purposes (information shared in this instance will not include the name or personal details, or any details that would disclose or identify you)


Counselling session agreement