Columbia Bible College

Student Counselling Services

Treatment Agreement

Confidentiality: What you share in your counselling sessions is confidential and cannot be released to anyone without your consent. This includes your Columbia staff and faculty, and your parents.

However, we are required by law to report if you are going to hurt yourself, hurt someone else, or if a child is in danger, in which case I am required to contactyour parents, hospital emergency, or other authority.
If I am subpoenaed by a court of law I may also be required to break confidentiality.
For the purposes of billing only, the CBC on-site accountant will be informed only of the number of sessions to be billed to your account.
Emails, texting, and cell phone conversations cannot be guaranteed as confidential.

Initials ______

Client Responsibility:Counselling is a collaborative process that involves making decisions regarding the pace of therapy, tasks, or procedures that may be recommended. It is your responsibility to fully participate in this process; you may accept or reject any suggestions made and are free discuss your decisions.

Counsellor Qualifications: The clinical counselling team consists of the Supervisor of Counselling Services, and highly trainedMaster’s level interns from Trinity Western University in their final year of training. You have the right to ask about your therapist’s professional qualifications, training and experience, and you can end therapy or request a referral to another counsellor at any time.

Clinical Supervision: Your counsellor may consult with the Supervisor and Clinical Team on your sessions, in orderto provide you with the highest quality of treatment. Your counsellor may discuss your progress with an outside Supervisor, in an anonymous way. Your counsellor may sometimes ask to record sessions; recording is optional, and you may refuse or retract your consent at any time.

Cancellation & Missed Appointments: Cancellationsrequire at least 24 hours’ notice, or you will be charged $24.00 for the missed session; this applies to students who have had fees waived. If you arrive late, it is not possible to make up the time at the end of the session.

Initials ______

Payment & Structure of the Session: Each 50 min. session is $12.00(waived for Leaders), billed monthly to your student account.

Emergency Contact Info: In case of emergency, please indicate the person(s) you would like us to contact.

Name: ______Phone: ______Relationship: ______

By signing you indicate that you understand and agree with the above information:

Print Name: ______Signature: ______Date: ______

2940 Clearbrook Road, Abbotsford BC V2T 2Z8 |Ph: 604.853.3358 | Toll-free: 800.283.0881 | Fax: 604.853.3063