Information and Consent Form

Prior to beginning with a new client I require a signed hardcopy [which I provide] of the following form. You can also download a pdf version of the form.

Svetlana Lilova, MA
Psychotherapist
64 Oxford Street
Toronto, Ontario
416 997 3733
info@svetlanalilova.com

Information

Svetlana Lilova holds a Master of Arts in Counselling Psychology and has been practising psychotherapy since 2004 at various settings with clients from diverse cultural and ethnic backgrounds.

Svetlana is currently in private practice and works out of 64 Oxford Street in Toronto. Svetlana provides experiential psychotherapy to adults, adolescents, and couples, with concerns and personal difficulties such as depression, anxiety, grief, despair and other existential concerns, relationship difficulties, career direction, abuse, trauma, low self-esteem, injury and pain, life transitions, just feeling stuck or lost, difficulties moving to action or getting things done, emotional intelligence, creativity, and presence.

What Happens in Therapy

The first psychotherapy appointment is primarily introductory and aims to answer any questions or concerns the person or couple may have; the person’s or couple’s goals or hopes for change as a result of therapy; and to determine whether Svetlana can meet the person’s or the couple’s needs.

The first session also indicates the fit between therapist and client – a very important factor in healing. It is hoped that clients would feel heard and understood; gain a sense of Svetlana’s style and approach to therapy; and get Svetlana’s opinion about his or her goals and how they would be achieved.

Subsequent sessions unfold collaboratively according to the uniqueness of the client and his or her personal goals and point along life’s journey. While the client does the actual work – introducing concerns, self-challenges, goals, and personal explorations, Svetlana helps create a safe, respectful, and empathic environment so that such work is possible. The client is believed to have innate wisdom which, with help, can be accessed so that he or she can move toward integration and wholeness.

Pricing

Therapy can be claimed as a medical expense for income tax purposes and you may be able to claim it as a professional expense depending on your employment contract. My services are not covered by OHIP. However, I accept third party health benefits.

A sliding scale is provided for clients who are financially constrained. You are welcome to discuss your situation.

Fees are set according to the recommended rates established by the Ontario Psychological Association and are based on level of training and experience. In addition to the service provided, the fees are designed to also cover space rental, additional time spent in related research, administration, and consultation.

Acceptable methods of payment include cash, personal cheques; credit and debit at the Oxford Street location; and electronic money transfers in the case of tele-therapy. Payment is due at the end of each session; a receipt is provided. Receipts may be submitted for reimbursement if a client has extended health benefits. Prospective clients are encouraged to investigate the provisions of their particular extended health benefits package before they make an initial appointment, and to inform of the need for extended health receipts.

Session Length

Individual therapy sessions are typically 55 minutes in length, with 5 minutes allocated to administrative tasks. Couples sessions are 80 minutes in length. The frequency of therapy can be discussed and agreed upon in initial sessions.

Cancellation Policy

I require that clients provide at least 24 hours notice if they find it necessary to cancel or change a scheduled appointment, as this courtesy gives me the option of offering my time to another client and avoiding unused office rental fees. The full session fee is charged for missed appointments and late cancellations.

Confidentiality

Svetlana Lilova maintains ethical and professional confidentiality regarding all personal health information clients disclose. Information will not be released to another person or organization without the clients’ written permission.

Consent Form

Your confidentiality is guaranteed with the following exceptions:
If you report intent to harm yourself in any manner,
If you report intent to harm someone else,
If you report any abuse or neglect of a child 16 years old or younger,
If you report abuse you received by another regulated health practitioner (i.e., Medical doctor, Chiropractor, Massage Therapist, Occupational Therapist), and
If clinical records are subpoenaed by court.

In these instances, your information needs to be released for the protection of yourself or others. Should either of these situations emerge, an attempt would be made to speak with you before disclosure.

If you have any questions that have not been answered by this information, please ask.

I / We have read the information in this form and accept the conditions of the practice set out above:

Name(s)_______________________________________

Signature(s) _____________________________________

Date _________________________________________