Start the Conversation Program

Statement of Understanding

Please complete this alongside your intake form if you are attending counselling through our Start the Conversation sliding scale program.

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We are pleased that you have chosen to begin this journey with us. This form outlines the arrangements with the third-party organization that referred you to our services. If you have any questions or need assistance at any time, please reach out. We are here to support you every step of the way.

Before you begin

  • A signature is required in one section. You can sign easily on any phone, tablet, or computer.
  • The form does not save progress, so please complete it in one sitting. It takes about 3 minutes.
  • Click Submit when you are done.

Statement of Understanding

Please review and complete the form below.

Statement of Understanding: Low-Cost Counselling Services

Thank you for accessing low-cost counselling services through Your Counselling Ltd. This Statement of Understanding outlines the nature of these services, your rights as a client, and key terms of engagement to ensure a transparent and supportive counselling process.

Purpose of Services

Your Counselling Ltd. offers short-term, solution-focused counselling at a reduced rate to make mental health support more accessible. These services are designed to provide support for a wide range of emotional, personal, and mental health challenges.

Delivery of Services

Low-cost counselling services are provided by Master’s level counselling or social work interns completing their practicum training. All interns work under the direct supervision of a qualified and registered mental health professional at Your Counselling Ltd. Supervision ensures that you receive appropriate, ethical, and effective care while also supporting the professional development of the intern.

If you have any concerns regarding the services you receive, you may request to speak with the supervising professional or contact our office directly.

Eligibility and Scope

Low-cost counselling services are available to individuals who meet eligibility criteria set by Your Counselling Ltd.

Clients are eligible for a limited number of reduced-rate sessions. Clients can access up to 12 subsidized sessions per calendar year, with the option of in-person or virtual counselling, depending on preference and therapist availability.

  • Adult Individuals (18+): $25 per session

Should you wish to continue counselling beyond the reduced-rate sessions, additional sessions may be arranged at our standard rates.

Confidentiality

Your privacy is of utmost importance. Information shared during counselling sessions is confidential, with the following exceptions:

  • If there is a risk of harm to yourself or others.
  • If there is suspicion or disclosure of abuse/neglect involving a child or vulnerable person.
  • If records are subpoenaed by a court of law.
  • When you provide written consent to share information with a third party.

No information about the content of your counselling sessions will be shared outside Your Counselling Ltd. without your consent.

Session Format and Duration

Counselling sessions will be provided in person.

Each session typically lasts 50 minutes.

Appointment times will be scheduled based on mutual availability. Clients must contact the office directly to schedule these.

This program is operating at the availability of our internship program, which typically runs from September to April. Referrals will be provided for continuation of services outside of our clinic.

Responsibilities of Clients

All clients are required to complete the standard Your Counselling Intake package prior to beginning counselling. A link will be sent to you to complete this process.

Limits of Service

Low-cost counselling services are designed for short-term support and may not meet the needs of individuals requiring:

  • Intensive, long-term intervention.
  • Cris​is or emergency care.
  • Specialized services beyond the scope of this program.
  • If your counsellor determines that additional or alternative support is required, appropriate referrals will be provided.
Client File Name
​Consent to Participate

By signing below, you acknowledge that you:

  • ​Understand the nature, scope, and limits of the low-cost counselling services provided.
  • Consent to participate in counselling sessions with Your Counselling Ltd.
  • Acknowledge your rights to confidentiality, exceptions to confidentiality, and your responsibilities as a client.

Thank you for trusting Your Counselling Ltd. to support your well-being. If you have any questions about this Statement of Understanding or the counselling process, please ask your counsellor or contact our office directly.

Click to indicate agreement
Clear Signature

If you run into any issues or have questions about this form, please contact our office. We are open Monday to Friday, 9am to 6pm. Outside of those hours, email reception@yourcounselling.ca.