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Thompson Rivers University
Thompson Rivers University

Intake Counselling Consent Form

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Welcome to Counselling Services. Today, we will talk about your concerns and make a plan together that will start to address your current need(s). This plan may include referrals to workshops or group sessions, short-term individual therapy and information about other helpful resources on and off campus. 
Student Information

About You

Your Concerns

Information for Us

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 250-828-5471, or by post to: TRU Counseling Office, 1645 - 835 University Dr. Kamloops, BC, V2C 0C8, alternatively you may contact the Privacy Office at

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.

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