Before starting sessions with me, you will be asked to agree to the terms stated below. Please email me at rachel@rgtherapy.ca with any questions.

 

SUBJECT TO CHANGE

Last updated: Mar. 6, 2026

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Rachel Ginsberg Counselling and Psychotherapy


INTRODUCTION

Before your first session, please review this form carefully. It explains how therapy works, your rights, and my responsibilities as a registered social worker. Please send any questions regarding this form to rachel@rgtherapy.ca.

You may be asked to review and re-sign this consent form once a year, or sooner if there are changes to my policies or services. You can find a copy of this form on my website for future reference.

If you do not have a credit card and would like to pay for sessions by e-transfer, please request an alternate version of this consent form by email at rachel@rgtherapy.ca.

 

CREDIT CARD INFORMATION

Your credit card information will be securely stored and will only be used to charge you for sessions, late cancellation/missed appointment fees, or other fees you have agreed to in advance. Charges will appear on your statement as “RACHEL GINSBERG COUNSE NORTH VANCOUV BC”.

ALTERNATE FORM: I agree to pay the full balance owing for services by e-transfer within 24 hours after each session. I understand that failure to pay within this timeframe may result in future sessions being cancelled, services being discontinued, and/or my bill being sent to collections. 

 

INSURANCE INFORMATION

If you have insurance benefits and you would like me to direct bill for my services, please upload your insurance information here. If your insurance provider is not listed, please send your insurance information to me at rachel@rgtherapy.ca.



RACHEL GINSBERG’S PROFESSIONAL CREDENTIALS

I hold a Master of Social Work (MSW) from the University of Toronto and am a Registered Social Worker (RSW) in good standing with the Ontario College of Social Workers and Social Service Workers (OCSWSSW). l provide counselling and practice the controlled act of psychotherapy, as authorized by the OCSWSSW.

Due to regulatory requirements, I can only provide services to clients who are physically present in Ontario, Nunavut, or the Yukon during sessions.

CLIENT: I confirm that I will be physically present in Ontario, Nunavut, or the Yukon for all sessions.

 

SERVICES OFFERED AND WHAT TO EXPECT

I provide individual therapy to adults (18+) in person, by video, and by phone.

I draw from a variety of types of therapy, including Dialectical Behaviour Therapy (DBT), Cognitive Behavioural Therapy (CBT), Motivational Interviewing, and parts work, and I am a Certified Clinical Trauma Professional, Level II (CCTP II).

We will discuss your current concerns relating to mental health, relationships, work or school, life goals, and other topics. We will work together to set goals and find strategies aimed at improving your mental health, overall well-being, and ability to solve problems.

I will check in regularly about how therapy is working for you. Please feel free to ask questions or raise concerns to me at any time so I can ensure that sessions are helpful and that we are working toward goals that are important to you. 

Reaching your goals in therapy is not always easy and requires commitment. I may suggest home practice for you to do outside of sessions. If you are having a hard time with the therapy process, I am happy to discuss this with you to figure out what might help you to be successful in reaching your goals.

CLIENT: I understand.

 

RISKS AND BENEFITS

Therapy is an opportunity to explore and process difficulties related to behaviours, thoughts, feelings, memories and relationships. It can provide greater self-awareness, insight, and skills for managing difficult aspects of life. Therapy may involve exploring unpleasant feelings, events or experiences which can lead to strong emotions or reactions. I will mitigate these risks by staying within my scope of practice, using evidence-based approaches, and regularly checking in with you. If at any time you feel worse as a result of our work together, please let me know so we can adjust our approach.

The risks of not engaging in therapy when it is needed may include mental health issues getting worse, as well as worsened functioning in many areas of life.

CLIENT: I understand.

 

CONFIDENTIALITY AND SAFETY

I take your privacy very seriously and will keep information about you and what is discussed in our sessions confidential. I comply with all applicable Canadian privacy laws related to health care. 

There are some limits to confidentiality, including situations where I am legally or ethically obligated to take action, even without your consent. 

Some examples include situations where:

  • I have a concern that a child or elderly person is being abused or neglected;
  • I believe you are at serious imminent risk of harming yourself or someone else;
  • a judge orders me to provide records or testimony as part of a court proceeding;
  • I become aware of sexual abuse committed by a regulated health professional; or
  • I am required to share information as part of an investigation by the OCSWSSW.


If one of the above situations occurs, I may need to take steps to protect your safety or the safety of others or to comply with the law. These steps may include any of the following: contacting your emergency contact, calling 911, warning any potential victim(s), making a report to the Children’s Aid Society, providing documentation or testimony regarding our sessions together, or notifying the police or a relevant regulatory body about a serious concern. Whenever possible, I will discuss these steps with you in advance.

For more information about the obligations of social workers or health information custodians, please visit:

https://www.ocswssw.org/sop/

https://www.ipc.on.ca/

CLIENT: I understand that confidentiality has legal and ethical limits and that in some situations Rachel may be required to share my personal information or information from our sessions with a third party.

 

CONSULTATION

I may occasionally consult with other mental health professionals as needed to support your care. If this occurs, your identity will be kept private. Engaging in regular consultation is considered a best practice, even for experienced therapists.

CLIENT: I understand.

 

RECORDKEEPING

I will keep your clinical records for at least 10 years after our sessions end, in compliance with the OCSWSSW Code of Ethics and Standards of Practice. Your records will only be accessible to myself, authorized administrative staff or service providers, and/or practicum students. I use Jane App software to store your records, which complies with Canadian privacy laws. 

Once a year, I will review my records and securely destroy any records that are over 10 years old unless, in my judgment, there is a reasonable possibility that future access to the record may be needed (such as, but not limited to, in cases involving minors, sexual abuse and/or current or future litigation).

CLIENT: I understand.

 

PHONE AND VIDEO SESSIONS

Virtual sessions will always take place using secure online platforms. While reasonable steps are taken to protect your privacy, virtual therapy involves some potential privacy risks, such as unauthorized access, data breaches, or interruptions in service beyond my control. I ask that you attend phone and video sessions from a private location using a secure device to help reduce these risks.

CLIENT: I understand the risks of virtual therapy and agree to take reasonable steps to protect my privacy.

 

PHONE AND VIDEO SESSIONS - DRIVING

Driving a vehicle during therapy is unsafe and makes it difficult to fully participate. Please do not drive during phone or video sessions.

CLIENT: I agree not to drive during phone or video sessions and I understand that doing so may result in my session being cancelled and a late cancellation fee being charged.

 

FEES AND CANCELLATION POLICY

My fee is $180 per 50-minute session (or a reduced fee agreed upon in advance) and payment is due within 24 hours after each session. Fees may increase once a year by $5-15. I will inform you in advance of any fee increase. 

Fees may be paid by credit card, e-transfer, or insurance direct billing. Fees charged to your credit card will appear on your statement as RACHEL GINSBERG COUNSE NORTH VANCOUV BC.

Reduced fees are reserved for clients with significant financial need and may be reviewed if the client’s circumstances change.

Appointments that are missed or cancelled with less than 24 hours’ notice will result in a charge of 75% of the session fee. Exceptions may be made on a case-by-case basis. Fees for late cancellations or missed appointments cannot be billed to insurance. 

If outstanding fees remain unpaid after multiple attempts to contact you, I may utilize collection agencies or legal proceedings in order to recover any balance owing on your account.

CLIENT: I understand the fees and cancellation policy. I understand that fees for late cancellations or missed appointments will NOT be billed to my insurance company and must be paid by credit card or e-transfer. 

 

INSURANCE DIRECT BILLING

I offer direct billing to many insurance companies. By signing below and providing me with your insurance policy information, you authorize payment for sessions to be made directly to me by your insurer. You are responsible for any remaining amounts not covered by your insurance. 

Some insurance policies only allow the policy holder to be reimbursed for the cost of services, not the service provider. In these cases, I will submit your insurance claim for you but you will be required to pay for the session by credit card or e-transfer. 

Please check with your insurance provider to ensure that services provided by a registered social worker (RSW) are covered.

CLIENT: I understand that I am responsible for any fees that are not covered by my insurance benefits. 

 

COMMUNICATION POLICY AND CRISIS SUPPORT

The best way to contact me is by email at rachel@rgtherapy.ca. Please do not send any sensitive information by email as it is not a secure form of communication. Any communication you send by email may become part of your client record.

Please note that I do not provide therapy by email and I do not connect with current or past clients on my personal social media accounts.

I am unable to provide support during emergencies or crises outside of scheduled appointments. If you are in crisis, please call 911, 988, or go to your nearest hospital emergency department. If there are concerns about how you will cope during a future crisis, we can discuss safety planning in advance during our sessions.

CLIENT: I understand that Rachel is unable to provide support during emergency or crisis situations and I agree to contact emergency services or a crisis line if I need urgent support outside of a scheduled appointment time.

 

TERMINATION OF SERVICES

Sometimes the relationship between a client and their therapist cannot or should not continue. As per the Code of Ethics and Standards of Practice set out by the OCSWSSW, I may terminate services with you when my services are no longer required or requested, there is a conflict of interest, or if one or more of the following situations exists:

  • you request that I terminate services;
  • you withdraw from my services;
  • my services no longer benefit you;
  • continuing to serve you would require me to violate ethical and/or legal requirements;
  • providing you with services has created a situation where my values, ethics and/or boundaries have been violated to the extent that I am unable to provide appropriate services;
  • you have repeatedly, and without adequate explanation, cancelled or changed appointment or meeting times to the extent that I experience or believe that financial hardship and/or service disruption will occur;
  • you are unable or unwilling to reimburse me for services rendered, when such reimbursement has been previously agreed to by you and is both appropriate and required as a condition of providing services; or 
  • continuing to provide the services would place me at serious risk of harm.
If any of the above occurs, I will make reasonable efforts to hold a termination session with you and provide an explanation for discontinuing services.

For more information, please visit:

CLIENT: I understand.

 

REQUESTS FOR DOCUMENTATION

I do not provide assessments or letters for legal matters, custody disputes, or emotional support animals, as they require specialized knowledge and qualifications that I do not possess. 

Other documentation requests may be considered on a case-by-case basis and fees may apply.

CLIENT: I understand that requests for documentation may be declined if they fall outside of Rachel’s areas of expertise.

 

PERSONAL INFORMATION CONSENT

CLIENT: I consent to the collection, use, and storage of my personal information for the purposes of billing and providing me with counselling and psychotherapy services.