Service AGREEMENT PLEASE READ AND SIGN BY CLICKING AGREE ON THE ONLINE FORM FOLLOWING, PRIOR TO SEEING Dr. Abuzinadah CONFIDENTIALITY: Confidentiality means that Dr. Abuzinadah has a responsibility to safeguard information obtained during counselling. All identifying information about your assessment and treatment is kept confidential, except as mandated by law. You must sign a release of information before any information about you is given to anyone, except as mandated by law. In certain situations, mental health professionals are required by law to reveal information obtained during therapy to other persons or agencies without your consent. In such situations, Dr. Abuzinadah is not required to inform you of her actions. Please note the following exceptions to confidentiality: • Confidentiality does not apply to cases of suspected abuse/neglect of children or the elderly. • Confidentiality does not apply to cases of potential harm to self or others. • A mental health professional may disclose confidential information in proceedings brought by a client against a professional. • Confidentiality does not apply to cases involving criminal proceedings, except communications by a person voluntarily involved in a substance abuse program. • Confidentiality may not apply in cases involving legal proceedings affecting the parent-child relationship. • Confidentiality may not apply to cases involving a minor child. In such cases, the mental health professional may advise a parent, managing conservator or guardian of a minor, with or without minor’s consent, of the treatment needed by or given to the minor. Dr Abuzinadah dose not engage in the controlled act of psychotherapy in Canada, she provides counselling and couching only. Dr Abuzinadah is not a psychiatrist, she is a mental health PhD holder. You consent to receiving emails from Dr Abuzinadah. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT: Dr. Abuzinadah is required by law to protect the privacy of your health information. Although your counselling record is the physical property of Dr. Abuzinadah the information contained in your health record belongs to you. You have the right to: • request a restriction on certain uses and disclosures of your information • inspect and obtain a copy of your health record • amend your health record as provided by regulation • obtain an accounting of disclosures of your health information as provided by law • request communications of your health care information by alternative means or locations • revoke your authorization to use or disclose health information except to the extent that action has already been taken. THE BENEFITS OF COUNSELING: One major benefit that may be gained from participating in counselling is the resolution of the concerns brought to therapy. Other possible benefits may be a better ability to cope with marital, family and other interpersonal relationships, and /or a greater understanding of personal goals and values. THE RISKS OF COUSNELING: There are certain risks involved in counselling. You may experience a variety of negative emotions during therapy as you remember and therapeutically resolve unpleasant events. Seeking to resolve concerns between family members, marital partners, and other persons can similarly lead to discomfort as well as relationship changes that may not be originally intended. The greatest risk of counselling is that it may not by itself resolve your concerns. Dr. Abuzinadah will do her best to assess progress and provide referral to other sources if that is deemed necessary and appropriate. Counselling is a collaborative process and the progress you make will depend in large measure upon your investment in the process. Dr. Abuzinadah will not be libel for under aged clients whom have parents’ consent . COST OF SERVICE The cost of service is stated on the booking page. PAYMENT OF FEES: All fees should be paid at the time of the booking. Most insurance plans have their own terms and conditions, this is your responsibility to follow up and check eligibility. Some insurance plans require the insured to call prior to the first visit and obtain authorization for a specified number of visits. If you fail to obtain this authorization prior to your initial counselling session, you are responsible for payment. INSURANCE CLAIMS Please remember that you are responsible for payment of all fees whether or not your health insurance provides reimbursement. CANCELLATIONS: Cancellations must be made 48 hours in advance to avoid charge. Missed appointments will be charged the regular fee. In the case of: no show, cancelation less than 48 hours or rescheduling the same appointment more than 1 time, clients are liable for of the appointment fees. Payment is due before that start of the session (you can pay by credit card). You appointments will be considered as no show if you have not joined the session in 15 minutes. Please note: our service fees vary and depend on your location due to individual countries regulations' and services. The service is approx. $150 CAD for 50 minutes for an individual session. and approx. $180 CAD FOR 75 minutes couples' and family sessions + service fees. Dr Yamam Abuzinadah is in no way liable for my health or safety. In consideration of my participation in the Counselling Services,
I understand that any therapies I undertake at Dr Yamam Abuzinadah Wellness Consultations are undertaken of my own free will. I accept that the ultimate responsibility for my health care is my own and that Dr Yamam Abuzinadah Wellness Consultations is here to support me in this. I understand that my practitioner reserves the right to determine which cases fall outside their scope of practice, in which event an appropriate referral will be recommended. My account will become deactivated if I did not book a retune appointment or connect with Dr Abuzinadah for more that 4 months time. I have read the above release and waiver of liability, and fully understand its contents and voluntarily agree to the terms and conditions stated.