• Participation in any and all recommended exercises and activities are of the full consent of the client(s).
• Fees are set on an hourly for individuals and up to 75 minutes for relationships. Payment is due at the end of the session unless otherwise arranged.
• Services are not covered by Manitoba Health. Services may be covered by third-party insurance policies. Clients are responsible for checking with their insurance company whether “sexology” is covered as well as limits of their policies.
• There are no charges for a cancellation made at least 24 hours prior the time of an appointment.
• Sessions cancelled the day of the appointment will be billed at half the agreed fee, except in the case of emergencies.
• If a client does not arrive within 20 minutes, the session is considered cancelled and will be billed accordingly.
• A full session fee will be charged for failing to cancel an appointment.
• Phone calls exceeding 15 minutes, other than the initial consultation, will be billed proportionately; as will professional phone consultations (e.g. physicians, physiotherapists, specialists, etc.) exceeding 15 minutes. These services will be billed proportionately at the hourly rate and undertaken only with the client’s explicit consent.
• Other than a referral initiated by Dr. Reece Malone, written reports to other professionals or third-parties will be billed proportionately at the hourly rate and undertaken only with the client’s explicit consent.
• Clients are billed interest at the rate of 1.5% monthly for outstanding balances more than 30 days, unless alternative arrangements have been made. Outstanding balances more than 90 day may be referred to a collection agency. Any time spent trying to collect unpaid balances will be billed at the agreed upon fee.
Sexuality Consultants and Support Services Manitoba, Inc. offers private and confidential services and will not release any personal information unless accompanied by a written consent form or by a court order. Discussion of client information in a manner that may reveal a client’s identity must take place only on a “need to communicate” basis. All notes, records, and communications are kept secure and confidential.
Data may be gathered from this information for statistical or teaching purposes but will be collected and shared in a non-identifying manner.
There are some limitations to confidentiality. Under certain circumstances, Sexuality Consultants and Support Services Manitoba, Inc. will be in a position in which staff cannot safeguard confidentiality. These circumstances include:
- Electronic communications such as email or third party video conferencing.
- If there is a disclosure, intension or threat to harm yourself, or another person, appropriate authorities will be contacted in order to ensure individual safety.
- By law, disclosures of child abuse (or vulnerable adult) in which a child (or vulnerable adult) has been harmed, or is at risk to be harmed will be reported to Child and Family Services or appropriate social services.
- Emergency situations such as a medical crisis.
This document policy outlines the provision of sex therapy services remotely using telecommunications technologies such as videoconferencing or telephone. Please review this information carefully.
Considerations related to Confidentiality
Because our session(s) will take place outside of my private office, there is the potential that others may overhear our conversation. On my end, I will take reasonable steps to ensure your privacy, such as only speaking with you while I am alone and in my private space or professional office and ensuring that I will not be interrupted during our session and others will not be able to overhear me.
It is also important for you to protect the privacy of our session by locating yourself in a space where others are not present, you will not be interrupted or disturbed, and where others are not likely to overhear our conversation. When possible, use of headphones is advised as this will reduce the amount of conversation that could be overheard by others.
Please note that the nature of electronic communications technology is such that, although highly unlikely, I cannot absolutely guarantee that our communications will be kept confidential or that others may not gain access to our communications. At this time, communication via telephone offers the greatest confidentiality next to in-person sessions.
If, during our session, you determine that you are no longer free to talk openly to me but are unable to say so, please use the code word “YELLOW.” If I hear you say these words, I will understand that you are not able to talk freely.
Considerations related to Safety
Because we will not be in the same physical space, I am limited in terms of the steps I can take to respond to emergencies and unsafe situations. Because of this, I will begin our session by:
· Asking you to tell me where you are located, including the street address and your specific location within the home;
· Asking you to let me know who else is in at the same location at that time;
· Asking you to identify an emergency contact person who is near to your location and who I can contact in the case of a crisis or emergency as well as a phone number at which I can contact this person. I will ask you to consent to my contacting this person should a crisis or emergency arise.
If our session is interrupted for any reason and you are having an emergency or crisis, do not call me back, but instead, call 911 or other emergency services (Adult Mobile Crisis Service at 204-940-1781; Clinic 24 Hour Crisis Line at 204-786-8686) or go to your nearest hospital emergency room. Call or text me back at 204-471-8771 after you have obtained emergency services and leave me a message indicating the same and I will call you back. If I don’t hear from you, I may contact your emergency contact person.
If, during our session, you are in an unsafe situation but feel you are not able to speak freely about this, please use the code word “RED STAR.” If I hear you say these words, I will understand that you are not safe and are unable to talk freely to me. In this case, I may contact emergency or your emergency contact person.
Considerations related to Unexpected Interruptions
If during our session, we are interrupted due to a breakdown in technology, accidental disconnection, or some other non-emergency circumstance, I will wait 30 seconds then attempt to reconnect with you.
If you do not receive a call back within 30 seconds to 1 minute, you can attempt to reconnect with me, and leave a message and/or send me an email at info@reecemalone.com.
Considerations related to Payment of Fees
The same fee rates apply for tele or video sessions as for in person sessions. Fees can be paid by eTransfer sent to info@reecemalone.com or via credit card which will require you to provide me with your card # and expiration date for manual key in.
Once I have received verification of payment, I will send you a receipt by email or per your preference.
Considerations related to Record Keeping
I want to ensure you that our sessions will not be recorded by me in any way, unless we mutually agree to do so before hand. Recording sessions require mutual agreement and signed consent.
I will maintain a record of our session, in the form of written client contact notes, in the same way that I maintain records of in-person sessions in accord with my policies.
Informed Consent for In-Person Services During COVID-19 Pandemic
This document contains important information about your decision to access in-person services in light of COVID-19. Please read this carefully and contact Dr. Reece Malone know if you have any questions. When you sign this document, it will be an deemed an official agreement.
Decision to Meet Face-to-Face
As we mutually agree to meet for in-person sessions however if there is a resurgence of the pandemic or if other health concerns arise, in-person sessions may be suspended. In this case, you will have the option to continue sessions online or by phone.
If you decide at any time that you would feel safer utilizing online services or prefer a phone session, the decision will be honored so long as it is clinically appropriate.
Risks of Opting for In-Person Services
You understand that by coming to the office, you are assuming the risk of exposure to COVID-19 (or other public health risk).
Your Responsibility to Minimize Your Exposure
To obtain services in person, you agree to take certain precautions which will help keep everyone including the clinician, their families, and other therapists and clients at 566 Corydon safer from exposure to COVID-19 or other public health risks. If you do not adhere to these safeguards, it may result in our starting / returning to online or a phone session arrangement.
Please read each of the following points:
- You will only keep your in-person appointment if you are symptom free.
- If you meet any of the following conditions, you will cancel your in-person appointment. These conditions include the presence of any possible symptoms of COVID-19 (fever, cough, sore throat / hoarse voice, difficulty breathing, chest pain, vomiting or diarrhea for more than 24 hours, loss of smell and taste). If you have any symptoms or concerns please call Health Links / Info Sante at 204-788-8200 or 1-888-0315-9257. If you cancel an in-person session for this reason and are not comfortable proceeding with an online or a phone session, you will not be charged the normal cancellation fee.
- When you enter the office space, please wash your hands or use alcohol-based hand sanitizer. Hand sanitizer will be available at the front door and there is soap and water in the washroom.
- If you would feel more comfortable wearing a protective mask, please do so. If you would prefer that the clinician also wear a mask, please let us know in advance.
- You will maintain the safe distancing precautions in all spaces of 566 Corydon.
- If you have interactions with others who become infected with COVID-19 you will let the clinician know immediately.
- If a resident of your home tests positive or has symptoms of COVID-19, you will immediately let the clinician know and we will then begin or resume online sessions or by phone until all members in your home have been deemed fully recovered.
These precautions may change if additional guidelines/recommendations are published by Manitoba Health. If that happens, you will be notified about any necessary changes.
My Commitment to Minimize Exposure
On an ongoing basis, I and other staff in the office will continue to take steps to reduce the risk of transmission of public health risks within the office. These steps can include requesting that people do not come early to appointments but rather come to the office no more than approximately 5 minutes prior to appointments, staggering appointments to limit the number of people in the waiting room and to allow for disinfecting between appointments, limiting the number of people in the office at any one time, maintaining physical distancing, disinfecting all high touch surfaces, and so forth. We ask that if possible, people use contactless payment (e.g., e-transfer).
If You or I Are Sick
I am committed to keeping you, me, others in our office, and all of our families safe from the spread of this virus. If you show up for an appointment and I or other members of our office believe that you have a fever or other symptoms, or believe you have been exposed, I will have to require you to leave the office immediately. We can follow up with online or phone sessions.
If I or others in our office have symptoms and/or test positive for COVID-19, I will immediately notify you so that you can take appropriate precautions.
Informed Consent
This agreement supplements the general informed consent agreements and other policies at the start of our work together.