Informed Consent and Confidentiality

Company Name: Goo Fusion Corp. T/A Anthony Santen SAC Dip. (Adv. Psychotherapy) Counselling Yorkville

Contact Information: My name is Anthony Santen. I can be contacted through my office at:
2 Bloor St. W, 19th Floor, Toronto, ON, M4W 3E2
or by telephone at 416-930-0186

Experience:
Most of my work is a derivative of over 20 years of cumulative experience with clients “in session” using my 'Dialectic Therapy Process' and research and findings in the areas of: “mental-health as a result of didactic, cognitive and environmental impacts and encoding of the human mind during development” as published in the book “The Path Within” ( Anthony Santen, Balboa Press – ISBN: 9781504325226)

Education and Training:
Stonebridge Associated Colleges – Diploma Psychotherapy (Advanced) – SAC Dip. (Adv. Psychotherapy)
Expert Rating – Certified Life Coach – CLC
Australian Institute of Business – Leadership and Strategic Marketing Management
Hypno-Healing Institute of Toronto – Certified Hypnotists CH and Mastery – MCH.
American University of Neurolinguistic Programming – NLP
Ontario Hypnosis Centre (NGH) – Certified Instructor – CI
Global College of Natural Medicine – Nutritional Consultant – NC
Robbins Madanes Institute – Strategic Intervention – Cloe Madanes, Anthony Robbins
The Living Institute – Existential-Integrative Psychotherapy
Influences: Brené Brown, Miguel Ruiz, Milton Erickson, John Bowlby, Abraham Maslow, Carl Jung.

I am a Member of the following associations:

Canadian Counselling and Psychotherapy Association CCPA – (Professional Member)
National Guild of Hypnotists NGH – (Faculty Member and Certified Instructor)
International Society for the Study of Behavioural Development – ISSBD – (Voting Member)
and I do annual continuing education to maintain my training at a high level.

Notice: As the province of Ontario has not adopted educational and training standards for the practice of hypnotism, coaching or counselling, this statement of credentials is for information purposes only.
Hypnotism is a self-regulating profession and its practitioners are not licensed by governments. Counselling is an un-regulated profession, closely related to the regulated profession of psychotherapist, but different in approach and limited in scope. Psychotherapy is an un-regulated profession divided between the ‘Controlled Act of Psychotherapy’ and Psychotherapy; also known as Counselling Psychotherapy. The Controlled Act of Psychotherapy in the process of becoming regulated via the College of Registered Psychotherapists (CRPO). The Health Professions Regulatory Advisory Council (HPRAC) has declared a distinction between psychotherapy & counselling as follows: “The practice of psychotherapy is distinct from both counselling, where the focus is on the provision of information, advice-giving, encouragement and instruction, and spiritual counselling, which is counselling related to religion or faith-based beliefs.” HPRAC: New Directions, 2006; Chapter 7, Regulation of Psychotherapy, p. 208. The College is not regulating counsellors or counselling. However, psychotherapy and counselling can be highly interrelated.

IMPORTANT
If you require medical treatment for a severe cognitive, emotional or behavioural disturbance, please consult directly with a licensed psychiatrist.
If you require the assessment for a severe cognitive, emotional or behavioural disturbance, please consult with a licensed psychologist.
As I do not engage in any regulated controlled act, nor am I a physician or a licensed health care provider, I do not provide a medical diagnosis nor recommend change of medically prescribed treatments.

If you desire a diagnosis or any other type of treatment from a licensed practitioner, you may seek such services at any time. In the event my services are terminated, you have a right to coordinated transfer of services to another practitioner. You have the right to refuse any service I offer at any time. You have a right to be free of physical, verbal or sexual abuse. You have a right to know the expected duration of sessions, and may assert any right without retaliation.

Ethics:
I am a Faculty Member of the National Guild of Hypnotists (NGH) and practice in accordance with the NGH Code of Ethics and Standards.
I am a Professional Member of the Canadian Counselling and Psychotherapy Association (CCPA) and practice in accordance with the CCPA Code of Ethics.

Fees:
Fee for time: Fees are charged as per agreement and subject to change with reasonable notice.
You are responsible to settle your bill at the end of each appointment. You may pay using Cash, Debit or Credit Card.

Pre-Paid session fees (Incl. Deposits to hold a timslot) are non-refundable.

Cancellations & Rescheduling & Refunds:

No one likes cancellation fees. I whish I didn't need to charge them, but I am unable to fill your timeslot at short notice. In order to keep my session prices reasonable I am asking that you absorb your own scheduling conflicts and emergency costs as follows:

Rescheduling or cancelling appointments with less than a full calendar day notice is subject to a $50 charge. This charge will be payable at your next session.
2 in 30 rule: If you cancel or move more than 2 sessions in a 30-day period, you will be charged full fee for the second and subsequent missed sessions before you can schedule any new appointments.
When I need to cancel your session with less than a full calendar day notice, I will deduct $50 from your next appointment.
Exception: If inclimate weather makes it dangerous to reach my office (when the TDSB closes the schools due to weather), no cancellation fees are due.

No-Shows: All no-shows are charged cancellation fees regardless of reason.

A full calendar day in this policy is defined as: Prior to 9:00am the day BEFORE the scheduled appointment. (example: If your appointment is on Wednesday at 2pm, cancellation fee is charged after 9:00am on Tuesday.)

Multiple appointments: In order to avoid calendar hogging clients may reserve an average of one timeslot per week in the online scheduler. Reserving more than an average of one timeslot per week requires a 50% non-refundable deposit.

Confidentiality: I will not release any information to anyone without a written authorization from you, except as provided for by law and in the following specific cases:

If I have good reason to believe that you will harm another person, I must attempt to inform that person and warn them of your intentions. I must also contact the police and ask them to protect your intended victim.
If I have good reason to believe that you are abusing or neglecting a child or vulnerable adult, or if you give me information about someone else who is doing this, I must inform Children’s Aid Society within 48 hours or the local police services immediately. If you are between the ages of 16 and 18 and you tell me that you are having sex with someone more than five years older than you, or sex with a teacher or a coach, I must also report this to CPS, even though at age 16 you have the right to consent to sex with someone no more than five years older than you. I would inform you before I took this action.

If I believe that you are in imminent danger of harming yourself, I may legally break confidentiality and call the police. I am not obligated to do this, and would explore all other options with you before I took this step. If at that point you were unwilling to take steps to guarantee your safety, I would call the police.
If you tell me of the behavior of another named health or mental health care provider that informs me that this person has either a. engaged in sexual contact with a patient, including yourself or b. is impaired from practice in some manner by cognitive, emotional, behavioral, or health problems, then the law requires me to report this to their licensing board as regulated in the Health Practitioner’s Act of Canada. I would inform you before taking this step. If you are my client and a health care provider, however, your confidentiality remains protected under the law from this kind of reporting.

The following is not a legal exception to your confidentiality. However, it is a policy you should be aware of: If you are in couples counselling with me. If you and your partner decide to have some individual sessions as part of the couples counselling, what you say in those individual sessions will be considered to be a part of the couples counselling, and can and probably will be discussed in our joint sessions. Do not tell me anything you wish kept secret from your partner.

Should you wish to disclose your relationship with me, or any content of our interactions to 3rd parties, or use the content of our sessions for commercial purposes, you hereby agree to obtain written permission and conditions from me first, whithout which you hereby fully indemnify me of any damages or costs associated with the recovery of loss due to libel, slander, copyright infringement, identity use or brand association, enforceable to the full extent of the law.

Records:
You have a right to be allowed access to my written record about you. I keep very brief records, noting only that you have been here, what topics were noteworthy in session. If you prefer that I keep no records, you must give me a written request to this effect for your file and I will only note the times and dates of your attendance in the record

Contact:
I may, from time to time, need to contact you regarding appointments. Due to the electronic scheduling I use to confirm appointments, I may contact you via phone, text message or email regarding your appointments. I will not leave any messages with 3rd parties, other than my name and number.

My Approach: I use an inter-personal approach, using various, and well documented techniques derived from study, certification, research and practice. Techniques and modalities are selected and used based on my training and knowledge during the session and may change as the sessions develop for each client. The inter-personal approach allows for a high level of client input on the resulting course of action to facilitate highest possible rate of progress. Please be aware that some modalities work in resistance with the client’s current thoughts or beliefs (Dialectic Therapy) and therefore may carry a potential emotional risk of approaching feelings or thoughts that you have avoided to think about or consider for a long time or that are dissimilar than your current beliefs or patterns may cause discomfort. Making changes in your beliefs, attitude or behaviors can be difficult, inconvenient and sometimes disruptive to your current situation. You may find your relationship with me to be a source of strong feelings, some of them uncomfortable at times. It is important that you consider carefully whether these risks are worth the benefits, to you, of the changes you seek. Most people who take these risks find that counselling is helpful. Please note if I feel that either you require assessment or treatment for a severe cognitive, emotional or behavioural disturbance or that continuing the sessions would fall beyond my qualifications, training or comfort level, I reserve the right to discontinue the sessions unilaterally. I may advise you to seek alternative treatment, but cannot guarantee that they will accept you for treatment.

Client Signature: I have received and read this Client Bill of Rights and understand what I have read.
(you can request a copy of this document at any time in the future)

Anthony Santen SAC Dip(Adv. Psychotherapy) Counselling in Toronto

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