Teen Talk Therapy – Consent for Therapy & Confidentiality Agreement

Email: sabrina@teentalktherapy.ca | sabrina.teentalktherapy@gmail.com
Virtual Sessions via: https://doxy.me/teentalktherapy

 
A Quick Note for Teens

Hey there!

I know therapy can feel new or even weird sometimes. Just know this is a space for you to talk, share, and get support in a way that feels right for you. What we talk about is mostly private — and I’ll only need to break that privacy if there’s a serious safety concern.

You don’t need to do anything with this form, but if you ever have questions, I’m here to help.

– Sabrina

 
Consent for Therapy (For Parents/Guardians)

I am the parent/legal guardian and I give consent for my child to receive individual therapy with Sabrina Hogan, M.Ed., B.Ed., B.A. (Advanced), C.C.C., RP (Qualifying), Psychological Associate (IP) Candidate.

 
What to Expect in Therapy

  • Therapy is a process — progress takes time, and setbacks are normal.

  • We’ll start with an assessment to help build goals together.

  • Sessions may include various therapy approaches based on your child’s needs.

  • Teens are encouraged to speak to a doctor if medical input is needed.

 
Fees & Payment

  • Individual sessions (50 minutes): $175.00

  • Group sessions (when available): $125.00 per session

Payment options:

  1. E-transfer to: payment@teentalktherapy.ca (preferred before the session)

  2. Credit card (charged securely after each session via Square)

 
Insurance Coverage

Sabrina Hogan is a:

  • Canadian Certified Counsellor (C.C.C.) with the CCPA (Canadian Counselling & Psychotherapy Association)

  • Registered Psychotherapist (Qualifying) with the CRPO (College of Registered Psychotherapists of Ontario)

  • Psychological Associate (Independent Practice) Candidate with PAM (Psychological Association of Manitoba) 

Many private insurance plans cover these designations. Please check with your insurer directly. A receipt with Sabrina’s license numbers will be issued after each session for reimbursement.

 

Direct Billing
If applicable, you may be eligible for direct billing. Fill out the information below related to your insurance if you are interested. 
 
Cancellations & Missed Sessions

  • 24 hours’ notice is required to cancel or reschedule

  • Missed or short-notice sessions will be charged the full fee

  • Exceptions may apply in special cases; please communicate any changes promptly

 
Confidentiality

What is shared in therapy stays private. Your teen’s session notes are stored securely. However, there are some exceptions to confidentiality:

  1. Safety: If your teen is at risk of harming themselves or someone else

  2. Abuse/neglect: If they disclose abuse of a person under 18

  3. Court order: If records are subpoenaed

  4. Consultation: General non-identifiable case consults may occur to improve care

  5. Substance use: In safety-sensitive roles, drug/alcohol use may be reported

Virtual sessions (e.g., Zoom or doxy.me) are encrypted but not guaranteed 100% secure.

 
Liability & Agreement

Sabrina Hogan is not liable for third-party claims or indirect damages.

By signing the digital form on https://teentalktherapy.ca/consent-form/, I acknowledge that I:

  • Understand the therapy process, fees, and confidentiality terms

  • Agree to provide 24 hours’ notice for cancellations

  • Understand that therapy is a collaborative effort

  • Have read and understood this agreement in full

 
Digital Signature (on form page below)

Please complete this at the bottom of the consent form page:

  •  I agree to the above terms and give my informed consent for therapy.

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Child's Name
Parent/Guardian Name
Second Parent/Guardian Name (If Applicable)
Address
Parental Consent for Child
Clear Signature