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Time Limited Consult (TLC)

AIM: To provide time-responsive support for a current pressing mental health related concern.

FORMAT: Brief solution-focussed session with a Counselling Services’ clinician, typically lasting 30 to 45 minutes. This can be facilitated either virtually (Zoom for Healthcare) or in-person.

CONTENT: Collaboration between you and the scheduled clinician to help facilitate insight, options, or immediate solutions to your current pressing concern. This may include: the provision of psychoeducation, therapeutic strategies, skill-developing tools, or resource suggestions.

A TLC is an initial standalone session, and therefore does not necessarily replace the process for requesting and accessing counselling services. Additional information, including wellness resources and your counselling options, can be found at: https://www.uregina.ca/student/counselling/

Thank you for using University of Regina Counselling Services. By completing this form, you will assist us in meeting your needs at this time.

Student Name* UR Student ID*
My current concern is regarding:
This is impacting my ability to function in the following areas:
I have already tried to address my concern or cope with my situation by:
Is there anything you feel is important for us to know about your culture, ethnicity, religion, language, sexual orientation, gender identity/expression, mental or physical health, or other?*

As a client accessing this consultation service, there are very important details regarding this process that you should be aware of at the onset:

  1. The benefit and goal of this brief solution-focused session is to receive support and devise strategies to help manage my immediate concern. However, despite my efforts and the efforts of my clinician, my situation may not improve, and in some cases may even get worse.
  2. For a virtual E-Session it is my responsibility to maintain privacy on the client end of the transmission and communication. I will take precautions such as using a private space, a secure and reliable internet connection, a headset, and muting in the event of an unexpected interruption. It is the responsibility of the clinician to do the same at their end. I know that despite all reasonable technology security efforts, there remains a risk that the transmission and communication of my E-Session may be breached and accessed by unauthorized persons.
  3. I agree that if I find myself in a life threatening or emergency situation, I will immediately call 9-1-1. If I require crisis-oriented mental health care services I will contact my local primary or nearest primary health care facility.
  4. In the event of a crisis concern, my local emergency contact is:
    Name*
    Relation*
    Telephone*
  5. The federal and provincial privacy laws (e.g. the Saskatchewan Health Information Protection Act), and the professional ethical standards of my clinician that protect the confidentiality of my health information, apply to in-person as well as virtual counselling. As such, I understand that the information disclosed by me during the course of my sessions (and over the telephone, by mail, or via email) will in general be kept confidential, and will be used to provide me with counselling and related services. I understand that my personal health information will not be released without my written consent unless required as noted below in the exceptions to confidentiality. Unless the situation is an emergency, consent must be provided in writing (signature required) and cannot be provided over the telephone or via email.
  6. I understand there are exceptions to the confidentiality obligations and privacy rights described above. These include, but are not limited to: reporting suspected neglect of, and harm to a child; addressing imminent risk of serious harm to self or others; providing information in response to a subpoena or court order; providing information required by legislation (e.g. SGI or WCB); and as otherwise permitted under The Local Authority Freedom of Information and Protection of Privacy Act.
  7. My client file will be maintained electronically on a secure server with Information Services of the University of Regina. Only my clinician and my clinician's immediate supervisor will have access to my client file. The information will be maintained for 7 years following the date of the last counselling services provided to me, as required by legislation. I understand that I have a right to access my client file information during or after services have ended.

I acknowledge that I have read, understand and have accept all the above statements relevant to receiving a Time Limited Consult with Counselling Services of the University of Regina:

Student Signature* Date*
Student Name* UR Student ID*
Email* Telephone*
I would like my TLC session to be: VIRTUAL E-SESSION
IN-PERSON SESSION