Informed Consent
Protecting your privacy and the information you provide is an important
principle of practice for Deborah R. Lain, and Hope for Tinnitus. As a
registered member of the College of Alberta Psychologists, Ms. Lain
adheres to strict privacy and confidentiality standards. As such, all of
the information you provide by phone, email, or in person is kept in
strict confidence.
The
information you provide will not be disclosed to any third party without
your written consent except in the following extreme circumstances:
-
intent to harm myself or another
-
abuse
of a minor (person under 18 years of age)
-
when
subpoenaed for any information by a court of law
I agree
to review the emergency resources that are available to me in my area of
residence. If at any point I enter a state of crisis and am an imminent
threat to myself or others, I take full responsibility for obtaining
immediate and appropriate assistance as well as for any actions I may
take. I understand that such situations require face-to-face intervention
and accept that crisis intervention cannot be conducted online. In the
event of an emergency, I agree to contact at least one of the following:
-
hospital emergency room
-
a
doctor
-
crisis line or agency
-
trusted adult friend or family member
I
understand that the Psychologist of Hope For Tinnitus is licensed and
registered to practice in the province of Alberta since 1983. If I reside
outside of Alberta, I understand and accept to take full responsibility
for informing myself of and complying with any laws regulating whom I may
seek counselling from.
Please refer also to the
Legal Disclaimer & Privacy Policy before signing.
I have
read and understood all the information on the Hope For Tinnitus website
regarding the nature of this practice.
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