Privacy and Confidentiality Policy Summary

Record #

Privacy and Confidentiality Policy Summary

It is our professional endeavor to maintain the highest professional standards in Clinical Psychology.  We responsibly comply with the laws of this country and province, and respect and follow the rules of confidentiality and all other ethical principles of the College of Psychologists of Ontario (CPO) and of the Canadian Psychological Association (CPA).

Our funding is derived from our own professional activities, and from grants awarded for research, educational, and service projects.  We strictly adhere to the ethical principles and standards of professional psychology in Canada, and do not accept any donations or funds that may compromise or limit our professional independence.

We do not endorse or recommend any commercial product or service, and any advertisement accepted to be included in our campaigns or products must rigorously adhere to our professional and ethical principles and standards, which specifically mandate that the nature of the advertisement must not promote any behavior, product, or activity that may be harmful to human beings, society, or Nature.

No commercial advertisement of any kind is accepted for display or exhibition at our offices or Internet website in connection to the rendering of our professional clinical services.

Please note that although we procure the best and safest electronic services we can afford, due to the inherent nature of the technology, we try to assure but CANNOT guarantee the confidentiality of the information obtained by our Internet, e-mail, and other related service providers, as well as by third parties beyond our knowledge.

If you are a client/patient, please include in your communications your name and your reason for contacting us.  Your communication may be viewed by multiple people in our institution.  Please make sure to provide your complete name, the name of your psychologist or specialist, and a telephone number where you can be reached, as well as a brief message detailing the reason for your contact.

BE AWARE THAT E-MAIL MESSAGES MAY BE DEEMED NOT SECURE.  To assure confidentiality and security of your information, we suggest you contact us in person, via telephone, or by fax.

The information you give us, including that which we obtain at our website, as well as all the information obtained throughout your psychotherapeutic treatment, is held in strict confidence by us, and this confidential information would only be divulged following your written prior authorization, when required by law, and/or when the situation would require it in the judgment of Dr. Pacheco and/or his Assistants and Collaborators.

By contacting us and/or by requesting our psychological services, you acknowledge and accept these terms, and those in our Privacy Policy.

We are ready to serve you to the best of our capabilities.  Our doors are open to anyone that needs or wants to live better.

 

We are here to help you…

Learn to Live Better ®

 

IMPORTANT NOTICES:

If required, call Dr. Pacheco and, if not available immediately, please leave a voice mail message with your name, telephone number, and a brief description of the situation.  Your call will be answered as soon as possible.

In the event of an emergency, call 911, or go to the nearest Hospital Emergency Room, where you will be assisted.

 

By signing this form, I confirm that:

  • I have read this form or it has been read to me, and that I have received a copy;
  • I have received a copy of the Privacy Policy, and of the Informed Consent for E-Mail or Text Communication;
  • I discussed and understand the contents and situations in which disclosure of my protected health care information may occur;
  • I understand the circumstances where Psychology staff will need to share information related to my case; and,
  • I understand and agree with all the points above.

 

ACCEPTED IN ACCORDANCE:

Printed Name                                                             Signature                                                             Date

 

 

 

 

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We are here to help you…

 Learn to Live Better ®

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