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Informed Consent and Agreement Policy

 Effective Date: May 10th, 2025

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Welcome to AE Therapy!

This document outlines the key policies that will guide our work together. Please take a moment to review the information carefully. If anything is unclear or if you have questions, feel free to bring them up during our session. 

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1. Confidentiality

Your privacy is a top priority. Everything discussed during our sessions is confidential, except in the following situations:

  • If there is a risk of harm to yourself or others.

  • If there is suspicion of child abuse, elder abuse, or neglect.

  • If required by law (e.g., in the case of a court order).

  • If you provide explicit, written consent to share your information with a third party.

In all other cases, your information remains private and protected.

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2. Session Structure

  • Duration: Each session is scheduled for a 60-minute slot. The actual therapy conversation will last 50 minutes, and the remaining 10 minutes are reserved for note writing and record-keeping.

  • Frequency: We will determine the frequency of sessions together based on your individual needs and preferences.

  • Format: Sessions can be conducted virtually, in-person, or as walk-and-talk sessions, based on mutual agreement.

 

​3. Fees and Payment

Standard Rate: The rate for each session is $175. It is your responsibility to check with your insurance provider prior to the session to confirm coverage for therapy services. 

  • Payment Methods: Payments are due before or at the end of each session via e-transfer (email to use for the e-transfer is info@aetherapy.ca). A receipt will be provided after payment, which can be submitted to your insurance provider for reimbursement. 

  • Late Payments: Payments that are more than 48 hours overdue may be subject to a late fee of $15. Therapy services will be paused until the outstanding balance is paid in full. If you anticipate a delay in payment, please communicate with me as soon as possible to avoid service interruption and additional fees.

  • Letters and Documentation: Letters requested for insurance, academic, or work-related purposes are subject to a $40 fee per letter. These letters will only be provided if they fall within the scope of my professional role and adhere to the ethical standards and guidelines of my regulatory body.

  • Insurance: Please confirm your insurance coverage and clarify both the maximum amount covered per session and the total coverage available per year before your first session. AE Therapy does not offer direct billing, but receipts are provided for you to submit claims.

 

4. Cancellations and Rescheduling

  • Notice Requirement: If you need to cancel or reschedule, please provide at least 24 hours' notice.

  • Missed Appointments: The full session fee will be charged for no-shows without prior notification.

  • Make-Up Sessions: Depending on availability, a make-up session may be offered at no additional cost if it is rescheduled and attended within 7 days of the originally scheduled session. To qualify for a free make-up session, payment for the missed appointment must be made on the same day the original session was scheduled. Otherwise, the make-up session will be charged at the regular rate.

 

5. Refund Policy 

  • If a session must be cancelled due to the therapist’s unforeseen circumstances and payment has already been made, a full refund will be issued using the original method of payment (e-transfer). Clients also have the option to apply the payment as a credit toward a future session.

 

6. Crisis and Emergency Support

AE Therapy is not equipped to offer emergency services. If you are in immediate crisis, please contact:

  • 911 or your local emergency services

  • Your nearest hospital emergency department

  • A 24-hour crisis hotline (e.g., the Distress Centre)

 

7. Therapeutic Relationship

Our therapeutic relationship is built on trust, openness, and collaboration. If you have any concerns or feedback, I encourage you to share them with me so we can address them together.

 

8. Ethical Standards

As a Registered Social Worker and Psychotherapist, I follow the ethical guidelines and standards of practice established by the Ontario College of Social Workers and Social Service Workers (OCSWSSW). I am committed to providing ethical, respectful, and professional care at all times.

 

9. Ending Therapy

You are free to end therapy at any time. When the time comes to conclude our work, we will discuss how best to close our sessions and make a plan for any next steps. You are always welcome to return for future support if needed.

 

10. Feedback

Your experience matters. If you have concerns or suggestions about your care, please don’t hesitate to share them—we’ll work together to ensure you feel supported!

 

 

Angelica Esposito, MA, MSW, RSW  

Registered Social Worker, Psychotherapist 

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