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In-Take Form

Terms & Conditions Below

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Terms & Conditions

This form provides information about the practice and privacy policies. This information is intended to help you make an informed decision about accepting our services by Clarinda Brandao, Registered Psychotherapist in Canada and an Individual & Couple Coach in Portugal. If you have any questions or concerns about anything on this form, please speak with Clarinda during your initial session before signing.

Frequency of Session: Weekly or bi-weekly 50-minute sessions are most common. The frequency of sessions is based largely on your needs. I recommend weekly for at least the first three months.

 

How long is therapy? The amount of sessions needed varies depending on the nature of each person’s concerns, the complexity of the issues involved and the strength of our working relationship.

Fees and Payment: Payment is at the end of each session rather than a regular billing process. Additional time beyond the 50-minute hour is billed in 10-minute increments. Fees are payable by cash or bank transfer or MBway.

In order to receive a receipt, please let me know in advance. I can issue a receipt under the Supervision of Dr. Jorge Gravanita, Registered Psychologist in Portugal.

Working With Couples (If applicable): As part of the assessment phase of therapy or as otherwise indicated, I may request to meet with each of you on an individual basis for one or more sessions after the initial first meeting. Unless you have specifically made a different agreement ahead of time with me and with your partner. As your therapist, I will use my professional judgment to decide whether, when and how to incorporate the information you’ve shared privately with me into your conjoint sessions and that disclosure of such private information by me to others in therapy with you is not considered a breach of confidentiality. The rationale for this policy is that it can be detrimental to the progress of your therapy or your relationship for me as your therapist to be in a position of having knowledge of sensitive information that the other spouse is not privy to, as it may put me into a conflict-of-interest position.

Privacy and Confidentiality:

  • All information you share with me as your therapist is private and confidential.

  • Your information will not be released to anyone without your written permission (with some exceptions as explained below).

  • When information is to be released with your consent you will be consulted.

  • Your information will be kept on file in a secure and private location.

 

Exceptions to Privacy - A client’s confidential information may be released without their consent under the following conditions:

  • When the purpose is to protect individuals (including a client) who are at foreseeable and imminent risk of bodily harm or death as a result of a client’s actions.

  • Under the law that requires reporting of a child, elder and/or professional caregiver abuse/neglect to authorities.

  • Under subpoena from a court of law.

  • If you disclose in confidence that you have done something illegal, as your therapist I am not obligated to report this to the authorities, unless the circumstances involve child abuse, abuse against a dependent adult, or a direct threat to another person.

24-Hour Cancellation Policy: If you cannot attend an appointment, please notify me 24 hours in advance.

Please cancel by phone (voice or text) or by email.

The purpose of the 24-hour cancellation policy is to allow enough time for us to fill the vacant appointment slot, thereby meeting

the needs of other clients who are waiting for an appointment. A same-day cancellation provides insufficient notice with which to

re-book an appointment, and thus represents both lost opportunity for someone else to benefit from that time slot as well as lost

revenue. There is, therefore, a fee charged for a late cancellation or missed appointment (Full session payment is due)

I understand that unforeseen events sometimes happen, but please let me know as soon as you can. Exceptions to this policy are

rare.

If you arrive late, the session will have to be shorter but will still be billed as though you had utilized the entire 50 minutes.

By agreeing you are aware of and agree to pay the late cancellation/missed appointment fee in the event that you cancel an appointment

with less than 24 hours' notice. You are aware that the charge is the full session rate of the appointment.

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