Confidentiality Agreement for Counseling Services
Confidentiality Agreement for Counseling Services
I, Nimir Raval, MSW, RSW, and Certified Coach, recognize the importance of confidentiality in counselling.

As your counsellor, I am committed to upholding the highest standards of privacy and protection of your personal information. By engaging in counselling services with me, you and I enter into the following agreement regarding the confidentiality of our interactions:

  1. Confidential Nature: I acknowledge that all information shared during our counselling sessions will be treated with the utmost confidentiality. This includes all verbal and written communications, records, and other personal information disclosed during our sessions.
  2. Exceptions to Confidentiality: I understand that there are specific circumstances under which confidentiality may be breached. These include situations where there is an immediate risk or harm to yourself or others, cases involving a child or vulnerable person protection from abuse, neglect, or danger, or instances where a court orders the release of information through a subpoena.
  3. Information Sharing: I will not share any information with you during our counselling sessions with anyone else without your explicit consent, except in the circumstances outlined above.
  4. Electronic Records: Any electronic records of our counselling sessions will be stored securely and in compliance with health information privacy standards to protect your personal information.
  5. Access to Records: You can access your counselling records with written and informed consent. Also, your records will only be released to another party with your consent.
  6. Neutrality and Professional Standards: I commit to remaining neutral in all matters involving third parties and following professional standards, including refraining from providing diagnostic assessments or serving as an expert witness in legal matters.
  7. Feedback and Concerns: I encourage open communication and respect your input. If you have any concerns about the confidentiality of our counselling services, I want you to know that I'm committed to addressing them promptly and effectively.
By entering into counselling services with me, you acknowledge and agree to the terms of this Confidentiality Agreement. This agreement ensures the privacy and protection of your personal information throughout our counselling relationship.

I CONSENT TO RECEIVE COUNSELLING: For me and/or my dependent(s)
I/We have read and understood Nimir Raval - Ei Growth Consent Agreement and discussed any questions with the Nimir Raval. I understand that I can withdraw my consent at any time.

Date - Consent Provided*