Online and/or Phone Counselling Consent Form
This consent form is in addition to the Privacy notice, and must be completed in order to access TRU Counselling
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.
I acknowledge that I have read, understand and agree to the information provided above regarding online
counselling. I provide my consent to receive online counselling, and understand that I may terminate sessions at
any time.
Emergency Contact Name
Emergency Contact Number
This form is prepared in accordance with University policy ADM 02-2, Confidentiality of Student Information and complies
with applicable federal and provincial legislation including the British Columbia Human Rights Code. For information about
this privacy notice please contact the Privacy office at 250-828-5012, or by post to: TRU Privacy Office, 805
TRU Way, Kamloops, BC, V2C 0C8.
TRU Student ID ________________________
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