Practice Policies

Forms for New Client

Client Intake


Client Mandatory 



Please note:

Clicking on a link will open the form in a new tab. Download the file to your computer and resave the document with your name, form name and date eg.(JSmith-Intake-Jan2015). Fill in the info and send back to me via email.

My work is based on the principles of my regulatory College and professional organizations I belong to. If I feel your situation is beyond my competency levels, I will refer you to another health professional.


Fee Schedule

Each session is scheduled to last 60 minutes or 90 minutes. We will discuss the details of your sessions in terms of duration, frequency, goals, etc. You can stop coming to appointments at any time you choose; however, if you don’t alert me ahead of time, I will not be in a position to assume professional responsibility for your care.


Payment Policy

All fees are paid in full at the time of each visit. Application for Fee Reduction is available for extenuating circumstances. For your convenience, available payment options are: Cash, visa, money order or interac, e-mail transfer. If you choose to use Interac e-mail Transfer, please use when logging on to your bank's web site.


Cancellation Policy

A cancellation policy of 24 hours in advance is in effect. No exception.


Extended Insurance Coverage Options

My fees are covered by many extended healthcare insurance plans. Please check with your plan provider regarding psychotherapy and counselling services covered and the limits of such coverage per hourly and yearly basis. It is your responsibility to submit completed forms to your insurance provider.


If you do not have Extended Insurance Coverage

If you do not have an extended healthcare insurance benefit plans, please know that as of September 26, 2012, counselling services provided by Registered Social Workers (MSWs, RSWs) can be claimed as a medical expense tax deduction when you file your income tax return. In other words, Registered Social Workers are now authorized “medical practitioners” for the purpose of claiming medical expenses. You can find more information at the following link: . I recommend that you speak to your accountant about your options.


Iva Keighley