Psychologist Life Coach
RENEE MEGGS
Registered Psychologist Focused Solutions Counselling and Coaching
CONSENT FOR TREATMENT
FOR COUPLE’S COUNSELLING
Surname:
Given Name(s):
Confidentiality: There are three circumstances in which Renée Meggs legally has to share the information you share with her: 1.If you are planning to kill yourself imminently. 2.If you are planning to hurt someone else and that includes children. 3.If you are involved in court and my files are subpoenaed.
Limits to Confidentiality and other informed consent discussions (We will discuss this together):
Fees: Renée charges $1999 for the 10-hour retreat. I understand the purpose and nature of these services, which has been explained to me by Renée Meggs, Registered Psychologist of Focused Solutions Counselling and Coaching.
Dated this day of 20
Mobile Phone Number;
Clear SIGNATURE OF CLIENT: