Groundwork Clinical Counselling Services

Client Intake

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Thank you for getting in contact with us. In order to ensure that we're a good working team, and that your needs will be met, please fill out the form below and we'll respond as soon as we're able to.

Please help us to understand what days/times you're available for sessions.
Use this space to tell us who you are, and what you're seeking.
Is there anything else you'd like to know, or you'd like us to know?

All information that you share with us is collected under the guidelines of the Freedom of Information act. Any disclosed information is used for the purpose of treatment planning and assessment only. Groundwork Clinical Counselling services maintains professional levels of information gathering, recording, and sharing. The personal rights and reputation of clients are respected at all times. In order for any information to be shared a Consent to Release Information form must be signed by you, the client. Exceptions to this agreement are:

  • Responding to the threat of harm to self or others
  • Responding to a medical emergency
  • Reporting risk of child abuse
  • Complying with subpoenas and other legal documents

Groundwork Clinical counselling services is also pleased to offer you Virtual Health as an option to receive care and services. Virtual health is a client-centered care model focused on connecting clients and providers using technology to promote wellness and improved outcomes.
If you agree to participate, it is important for you to understand:

  • We will require your email address to send you information as needed. Emails sent to some webmail services may be stored/routed outside of Canada.
  • Video conferencing platforms – Personal information (name, email address and ISP) for some video applications may be stored/routed outside of Canada. There is a possibility your information could be intercepted by unauthorized third parties. Groundwork Clinical counselling is not responsible or liable for compromised online communication between you and your counsellor. It is important to keep your login details secure and private, routinely update and check your computer system for viruses and trojans. Recording of virtual sessions is a violation of our confidentiality agreement and is strictly prohibited.
  • Telephone counselling –Cell phones or cordless phones are less secure and may be vulnerable to being tapped with loss of privacy.
  • SMS text – Some cell phone plan providers may store and route your information outside of Canada.

Your information will be encrypted.

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