Online and/or Phone Counselling Consent Form
Online counselling services are provided via telephone conversations or using interactive audio, video, or data
communications. I understand that there is a risk of being overheard by anyone near me if I am not in a private room
while participating in online counselling. I am responsible for (1) providing the necessary computer, telecommunications
equipment and internet access for my online counselling sessions, and (2) arranging a
location with sufficient lighting and privacy that is free from distractions or intrusions for my online counselling
session. It is the responsibility of the TRU counsellor to do the same on their end. I understand that video or
phone counselling sessions are NOT recorded to ensure my confidentiality.
I understand that there are risks and consequences of participating in online counselling, including, but not
limited to, the possibility, despite best efforts to ensure high encryption and secure technology on the part of
my counsellor, that: the transmission of my information could be disrupted or distorted by technical failures; the
transmission of my information could be interrupted by unauthorized persons; and/or the electronic storage of
my personal information could be accessed by unauthorized persons.
I understand that assessing and evaluating threats and other emergencies can be more difficult when
participating in online counselling than in traditional in-person counselling. So before engaging in online
counselling services, I have identified an emergency contact person who is near my location and can be
contacted in the event of a crisis or emergency to assist in addressing the situation.
Privacy Notification and Consent
Thompson Rivers University (TRU) collects, uses, discloses and retains personal information in
compliance with the BC Freedom of Information and Protection of Privacy Act (the “Act”). Staff and
faculty within TRU work closely together to provide services as a multidisciplinary team. Your
personal information is being collected as permitted under section 26(c) of the Act, and used for the
purpose of facilitating supports and academic accommodations or for a purpose consistent with these
uses, and is only shared with members of TRU on a need-to-know basis.
This information will be retain in accordance with TRU's Records Retention/Destruction Policy. For
information about this privacy notice please contact the CASA Chair at
or by post to:
TRU Counseling Office, 1645 - 835 University Dr. Kamloops, BC, V2C 0C8,
alternatively you may contact the Privacy Office at email@example.com
Faculty and Open Learning Faculty Members do not have access to detailed information regarding
student use of Student Services; however, general information about academic accommodations related
to an education plan may be provided. Detailed medical information, including diagnosis, remains
confidential within the Student Services area (Counselling, Accessibility Services, Student Affairs or
Student Awards & Financial Aid) unless required by law (see below).
Student Services uses software to manage information including appointments, services and contacts
with the office, as well as to maintain statistics for annual reports to the Ministry of Advanced Education.
These reports do not divulge a student’s identity.
Certain circumstances may require us to share information as directed by law, which include but are not
limited to the following situations: known and suspected instances of children who are or may be in need
of protection, cases involving imminent risk of physical harm to oneself or another, or when ordered by
subpoena for records or testimony.