Thank you for completing the client info form. 
I look forward to starting our work together!
What is your full name?

What is your full address? Please include postal code. Thanks.

What is the phone number that I can reach you at?

What is your email address?

What is your age?

If you are in High School, please let me know what grade level you currently in (or going into).

How did you hear about my career counselling services?

What motivated you to seek career counselling?

What are your hopes/goals for career counselling?

If there are any factors or issues that you think I should be aware of please explain briefly.

As a Canadian Certified Counsellor of the Canadian Counselling and Psychotherapy Association, I follow ethical responsibilities of my profession. Please review the following confidentiality agreement and just let me know if you have any questions or concerns.

Career Counselling Agreement *

My Role As A Counsellor
I see my role as a facilitator where I help you explore and find the answers that you need. I also provide objective guidance, challenge and support. I will listen without judgment, help you to identify and clarify your self-understanding and knowledge and aid you in locating relevant resources. I will support you in making your own decisions. If we find your concerns are focused on issues outside my expertise, I may refer you to a more appropriate resource.
Your Role as A Client
In order to achieve your goals it is important that you take an active role in the process. If you are open to new ideas, willing to take risks and honestly express your thoughts and feelings, we will be able to work most effectively. Following through on activities we discuss in session will also aid in a successful counselling process.
Your Rights As A Client
You have the right to end our counselling at any point. I consider everything we discuss to be confidential unless the topic is governed by the law, such as an intent to harm self or others or evidence of child abuse. I may wish to discuss our conversation with my professional colleagues in order to better serve you or I may be legally obligated to supply information about our work together. If we determine you may be assisted by another professional, you may wish for me to share information about our work together. With your permission and a written consent form I would be happy to serve in this role.
My Credentials and Work Experience
I have a Master of Education in Counselling Psychology from McGill University and I am a Canadian Certified Counsellor through the Canadian Counselling and Psychotherapy Association.  I have over 15 years experience in career development field including the last 10 years working at McMaster University, Hamilton, as a Career Counsellor where I continue to work full time.
Fee & Payment
My fee schedule is $95/session for in person or phone counselling and the sessions are 50 minutes. There is an additional fee for Career Assessments ($50) which will be discussed and agreed upon prior to implementing.   For phone counselling, payment is required prior to session and for in person counselling, payment is required  at the end of each session. As I am not a registered health professional, typically health benefits do NOT cover this service. Please provide at least 24 hour notice to cancel or reschedule appointments (thanks).   
The amount of time needed to address a client’s concern can vary.  The counselling process is one of trust and is a keystone of the relationship I have with my clients. Mutual respect and integrity is paramount as is confidentiality and responsibility. I ask that all my clients read and agree to the  Agreement for Counselling before our first session. If you have any questions, please feel free to contact me.
If there is anything you would like to add, please do so here. Thanks.

Thank you for completing the form. I look forward to meeting with you.

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