POLICIES

Intake Form Privacy & Confidentiality — Consents

Confidentiality, Limits of Confidentiality, Statement of understanding

All psychological services are confidential within Amy Moroz Psychological Services. Your workplace/professional association, family or doctor will not receive any information disclosing the identity of those who utilize psychological services without your written permission. We are legally obligated to report any suspicion of child or elder abuse that may involve you. We are obligated to breach confidentiality to the extent that it is necessary to ensure either your safety or the safety of someone else if you express an intention to harm another person. We are also obligated to breach confidentiality if you inform me/us that you have been sexually abused by a Regulated Health Care Professional. Finally, a court of law may have occasion to subpoena records we keep about you, and if this happens, we are bound to present them. Although these are rare circumstances, you should be aware of them when undertaking psychological services.

 

Technology Policy

Regardless of the provider (ie.Rogers/Bell etc) email, faxing and texting are not secure methods of communication and can be intercepted. We do not offer encrypted email at this time. Our health management software, through Jane, is encrypted with multiple layers and we have been assured that access within Jane is severely restricted, such that programmers, employees, and so on, do not have access to private health information of clients. You authorize faxing, emailing and electronic transmission of encrypted and unencrypted health information including the reminder of appointments. You agree you have been informed and understand the risks of accidental disclosure, the risks of interception of electronic communication and so on.

 

Cancellation Policy

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 person and impacts on our ability to maintain a viable business. As such, we require a minimum of 48 hours notice for any cancellations or changes to your appointment. Clients who provide less than this notice, or miss their appointment, will be charged the FULL FEE for the session. Thank you for your understanding and cooperation, it is greatly appreciated.

 

Risks and Benefits

Psychological assessment and treatment, psychotherapy, counselling or coaching may involved the risk of remembering unpleasant events, feeling unfamiliar sensations or arouse strong or unanticipated feelings or memories. You may face issues or aspects of yourself that are uncomfortable, and counselling may lead to unforeseen changes in your relationships, or take you outside of your comfort zone to exposure and expand your growing edge. Benefits may include an increased ability to live more effectively, by improving your ability to cope with difficult emotions, thoughts, and problematic behaviours. Improve your ability to cope with a variety of stressors and life challenges. Improve your ability to live more in the present moment, and less in the past and future. You may also gain a better understanding of yourself, your goals and values, which can assist in personal and career growth. You may experience relief or resolution from traumatic stress symptoms, develop skills, increase resilency and develop healthier relationships with yourself and those around you.

 

Your Responsibilities

Personal commitment to our work together is crucial for success. In order to maximize the effectiveness of psychological and therapeutic services, we suggest that you make counselling a high priority and not cancel sessions except in the case of an emergency. It is important to you be active, open and honest in your sessions. Your most important responsibility is to work toward the goals you and your therapist have agreed upon.

Seeing a Psychologist or therapist is often enhanced with additional efforts made between sessions such as : thinking about the material covered in your sessions, monitoring the behaviours you are trying to change, reading a book or article, completing worksheets, practicing new skills or taking other concrete actions to support your growth. It is your responsibility to tell us if you are uncomfortable with any parts of the treatment. If you have questions please ask.

 

Privacy and Record Keeping

Psychologists and therapists are required by law to keep a record of each contact and therapy session with a client. Records are kept for a minimum of 10 years after a client turns 18 years of age. All information is maintained in compliance with the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Federal Government of Canada and the Personal Health and Protection Act (PHIPA) of the Province of Ontario. This means that all personal information obtained, used and disclosed in therapy sessions is done so with your consent. Your personal information is protected by specific safeguards including locked cabinets and computer passwords. You may request a copy of your records for a reasonable fee. Please note that records cannot be released when they contain the name of another person and that reports from other professionals cannot be released without the consent of that professional.

 

Informed Consent

Informed consent is essential and out of respect for your right to choice and self-determination. Consent must be given voluntarily, knowingly and intelligently. You have the right to change your mind and withdraw informed consent at anytime, terminate treatment or refuse a particular treatment modality if you are not comfortable with it.

 

Supervision of Clinical Associates

Amy Moroz, M.Ed.C.Psych is a Registered Clinical & Counselling Psychologist (#5325) with the College of Psychologists of Ontario. Information about your care is shared with Amy Moroz for the purposes of providing treatment and/or for preparing reports on your behalf.

Clinical Associates Lauren Boni, M.Sc. is a Registered Psychotherapist with the College of Psychotherapists of Ontario (#8021) and is supervised/under the clinical direction of Amy Moroz, M.Ed.C.Psych. for your optimal clinical care.

Susan Hanna, B.A., M.S.W., R.S.W. is a Registered Social Worker with the Ontario College of Social Workers and Social Service Workers (#420971) is supervised/under the clinical direction of Amy Moroz, M.Ed.C.Psych. for your optimal clinical care. Susan Hanna is an Associate under contract with Amy Moroz Psychological Services.

Communication via Amy Moroz and your Clinician, occurs in person, by telephone, by fax and electronically (email) via your treatment. To every extent possible we try to ensure privacy. By signing below you agree and understand to the transmission of your documentation electronically. You understand that regardless of the provider (ie.Rogers, Bell, etc.), email is not a totally secure method of communication and can be intercepted. By signing below you authorize faxing and electronic communication of your unencrypted health information including reminders of appts. You agree you have been informed and understand the risks of accidental disclosure, risks of interception of electronic communication and so on.

 

Consent for Videoconferencing/Telephone

Amy Moroz Psychological Services (AMPS) offers patients within Ontario, Canada, the ability to communicate via the videoconferencing platform, Vsee, Skype, FaceTime or other similar platforms, as well as by telephone if the arrangement is agreed to by both parties.

Amy Moroz, M.Ed.C.Psych. and AMPS cannot and does not guarantee the privacy or security of any session content being sent over the internet./phone There is potential that videoconferencing or telephone sessions via Vsee, Skype, Facetime can be intercepted and reviewed by others, and it is possible that there could be disruptions to therapy due to technological difficulties.

I understand that communicating via the internet or phone is not 100% secure.

Public parts of your Skype profile can be seen by everyone else on Skype, FaceTime or similar products. Do not put details in your profile that you do not want to be publicly available. Vsee, Skype or other providers may disclose personal information to respond to legal requirements, to protect their business interests, to enforce their policies, or to protect anyone’s rights, property or safety. For more information about Skype security and privacy, please see: http://www.skype.com/en/security/. It is your responsibility to investigate and conduct your due diligence prior to beginning videoconferencing therapy.

Agreement

Patients who are experiencing suicidal ideation may not be ideal candidates for Videoconferencing sessions. I understand that if Amy Moroz, M.Ed.C.Psych. or other clinical associates of AMPS think I would be better served by another form of psychotherapy services (eg.face to face, in person sessions) even if videoconference therapy has already begun, she/they will either refer me to participate in face to face sessions, or another therapist who can provide such services in my area.

If I am in a crisis, emergency or I am considering seriously harming myself or others, I agree that I will dial 911 or go to the hospital. If our telephone/video call gets disconnected then please call back in, text or email so we can reconnect.

I have been informed and understand the risks and procedures involved with using the videoconferencing technology, Jane, VSee, Skype or FaceTime or similar products. I agree to the terms listed above and I hereby voluntarily consent to the use of Skype, FaceTime or similar platform for therapy sessions with my provider.

I agree that Amy Moroz, M.Ed.C.Psych or AMPS should/will not be held liable in the event that an outside/third party passes Skype, FaceTime, Jane, Vsee or other similar platform’s security and discovers personal or confidential information.

 

Payment Policy

Fees are listed on the website and are payable at the end of each session by etransfer, credit card (Visa and Master Card) through the website or our health management system. For in office appts we can accept debit. If you have benefits you can submit your receipts for the appointments directly to your insurer for reimbursement back to you. If payment is not received within 1 week, we reserve the right to utilize collection agencies to procure payment. If have any questions regarding payments please speak to us directly.

 

Insurance Company Confirmation of Sessions

In situations where you have submitted receipt to your insurance provider for reimbursement, they may contact AMPS to confirm, date, time and amount of session. These are situations in which you have an agreement with the insurance company that permits AMPS to disclose that specific information to them. If you have any questions about this please contact your insurance provider.

 

 

 

 

Videotaping of Video Sessions Prohibited

Videotaping of video sessions are prohibited, unless agreed to by Amy Moroz, M.Ed.C.Psych and Amy Moroz Psychological Services and the client. If AMPS discovers that there has been videotaping of sessions, this may result in treatment termination.

 

Gold nuggets

AMPS is partnering with a company (ie.MailChimp/Constant Contact) that would permit me to send you occasional gold nuggets of information that I think are worthy of sharing with you. I will be discerning in what I send out to you. If you agree then your email information will be stored with this company so that I can send the information in one batch as opposed to emailing each person directly. If you have questions let me know.

 

Appointment Notifications and Reminders

You can opt to receive emails to keep you informed of new bookings, changes to your bookings, and reminders for upcoming appointments.