Informed Consent

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

Contact Information:
My name is Anthony Santen.
I can be contacted through my office at:
167-5307 Victoria Drive, Vancouver, BC, V5P 3V6 (604) 345-2552

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.

Memberships:
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.
I am not a registered member of the College of Registered Psychotherapists of Ontario.

Notice:
The province of Ontario has not adopted educational and training standards for hypnotism, coaching or counselling, so 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 unregulated profession, closely related to psychotherapy, but different in approach and limited in scope.
Psychotherapy is a partially regulated profession divided between the ‘Controlled Act of Psychotherapy’ (Controlled Act) and Psychotherapy, more commonly known as Counselling Psychotherapy.
The Controlled Act is reserved for Registered Psychotherapists (RP) who, through the privilege bestowed through their title and registration, may diagnose and treat severe cases of cognitive, emotional or behavioural disturbances that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning. This means that some cases may be out of scope; in such cases, I will refer you to a Registered Psychotherapist, Registered Psychologist or Licensed Psychiatrist.

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 (CRPO) is not regulating counsellors or counselling. However, psychotherapy and counselling can be highly interrelated. The College (CRPO) is also not regulating psychotherapy outside of the scope of 'The Controlled Act of Psychotherapy.' The College (CRPO) prescribes the methods and practices considered within the scope of the Controlled Act.

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 a 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 anytime. If my services are terminated, you have a right to coordinate the 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 for settling your bill at the end of each appointment. You may pay using Cash, Debit or Credit Card.

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

Guarantees:
Some packages include a progress or price guarantee or a combination of progress and price guarantee. All warranties are subject to "Intentional and Deliberate Participation" by the client. This means doing homework between sessions. This also means active participation in presented solution attempts and exercises during sessions. This also means attempting to make progress toward the intended goals. No-Shows, lack of homework, unpaid fees or lack of "Intentional and Deliberate Participation" immediately voids any and all guarantees.

Cancellations & Rescheduling & Refunds:
No one likes cancellation fees, and I wish I didn't need to charge them, but I cannot fill your timeslot at short notice. Therefore, 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 cancellation fee. This fee will be payable before your next session.
2 in 30 rule: If you cancel or move 2 or more sessions in a 30-day period, you will be charged a full fee for the second and subsequent missed sessions before you can schedule any new appointments AND all future sessions are removed from the calendar.
2 in-a-row rule:  If you cancel or move 2 or more subsequent sessions, you will be charged the full fee for the second and subsequent missed sessions before you can schedule any new appointments AND all future sessions are removed from the calendar.
When I need to cancel your session with less than a full calendar day's notice, I will deduct the cancellation fee from your next appointment (i.e. credit your account).
Exception: If inclimate weather makes it dangerous to reach my office (when school buses are cancelled due to weather), no cancellation fees are due.

No-Shows: All no-shows are charged cancellation fees regardless of the reason.
Homework: Not completing homework assignments before a session is considered equivalent to a No-Show.

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

Multiple appointments:
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 written authorization from you except as provided for by law and in the following specific cases:

Imminent harm:
If I have good reason to believe that you intend to harm another person, I must attempt to inform that person and warn them of your intentions. I must also contact appropriate authorities and ask them to protect your intended victim.
Abuse: 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 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 the age of 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.

Self-harm:
If I believe you are in imminent danger of harming yourself, I may legally break confidentiality and call the police. However, I am not obligated to do this and would explore all other options with you before I take this step. If you were unwilling to take steps to guarantee your safety at that point, I would call the police.
Other health care provider: If you tell me of the behaviour 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, behavioural, 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 will inform you before taking this step. Sexual contact exception: if YOU are my client and a health care provider, however, your confidentiality remains protected under the law from this kind of reporting, and I can continue our sessions in confidentiality. You would still be subject to above noted 'imminent danger' stipulations.

Cross-over:
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 part of the couples counselling and can and probably will be discussed in our joint sessions. So do not tell me anything you wish kept secret from your partner.

Publication:
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 publication of any kind, you hereby agree to obtain written permission and conditions from me first, without which you hereby fully indemnify me of any damages or costs associated with the recovery of a loss due to libel, slander, copyright infringement, identity use or brand association, enforceable to the full extent of the law AND your disclosure implies explicitly a release of your rights to confidentiality, as defined in this agreement, to be applied at my sole discretion.

Records:
You have a right to access my written record about you. I keep very brief records, noting only that you have been here and what topics were noteworthy in the session. If you prefer that I hold 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 besides my name and number.

My Approach:
I use an interpersonal approach, using various techniques derived from study, certification, research and practice. Methods 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 interpersonal approach allows for a high level of client input on the resulting course of action to facilitate the highest possible rate of progress. Please be aware that some modalities work in resistance to 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 thinking about or considering for a long time or that are dissimilar than your current beliefs or patterns may cause discomfort. Changing your beliefs, attitude, or behaviours can be difficult, inconvenient and sometimes disruptive to your current situation. You may find your relationship with me a source of strong feelings, some of them at times uncomfortable. You must consider carefully whether these risks are worth the benefits 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 I cannot guarantee that they will accept you for treatment.

Client Electronic Signature:
I have received and read this Client Bill of Rights and understand what I have read. An electronic signature is obtained by selecting the non-optional checkbox on the appointment form. If you do not wish to be bound by this agreement, please do not check the box on the appointment form.
(you can request a copy of this document at any time in the future)

Contact Info

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