COVID-19 Healthcare Response Agreement

If you’re a healthcare worker applying for our free counselling services, please complete this form and email it to: and our office will contact you to book your initial meeting with your counsellor or you can call us on 6049040898

To Download this Agreement Click Here…

The Bach Counselling Group has provided evidence-based counselling and mental health support in the community for over 25 years. In response to COVID-19, we are providing practical support to individuals and families in British Columbia on the frontlines in English and Farsi.

Independent licensed counsellors are joining with us to be paired with frontline workers offering FREE tele-health/video or phone counselling for up to 6 weeks commencing on April 1st.  This could include clients dealing with anxiety, depression, anger, family relationships, community isolation, loss and workplace stress. Goals for counselling will be set in the first meeting to assist you in managing your current situation. Please note that the FREE counselling is for the purpose of providing mental health support relating directly to the COVID-19 crisis.If the clients would like to continue with their therapist beyond this time, this can be discussed with their therapist. If the client presents with severe high risk, the counsellor will refer the client accordingly to insure they are cared for with the best possible manner.

Tele-Health/Video Counselling

Given the current circumstances of COVID-19 all meetings will take place through video or phone. The nature of this counselling limits the level of confidentiality and signing this agreement acknowledges that you agree to this. We do use platforms that adhere to Canada Law, the Personal Information Protection of Electronic Documents Act PIPEDA. Your IP address however could be stored. The client agrees to arrange and be responsible for privacy during meeting times. (An article with more information on how to prepare for tele-health counselling will be available.)

Once the client completes and submits, the approval form to participate in free counselling, they will be scheduled for their initial intake meeting. In the first meeting with the counsellor,  50 minutes, further meetings will be discussed regarding how the client and counsellor will use the 50 minutes a week to best suit the clients needs. This could be one meeting a week of two 25 minute video or phone meetings. The client and counsellor will schedule the appointment times and review the best form of communication.

Limits to Tele-Health Counselling 

This free Tele-health counselling is limited to emotional and mental health support as it relates directly to COVID-19 and is limited in scope. Clients struggling with more severe mental health concerns including safety of self or other, agree to contact the Crisis and Suicide Prevention centre of BC at 604 872-3311 or proceed to the nearest emergency department.


The clients information is kept confidential adhering to professional standards of counselling practice with the exception of harm to self, other or the counsellor is ordered by the courts to disclose information about the client. This will be discussed with the client if exceptions occur. This includes the client’s disclosure of their location at the onset of each meeting.


  • Provide a copy of their licence and insurance to BCG
  • Review informed consent in the initial meeting with the client
  • Assume responsibility and risk working with referred clients
  • Agree to use only PIPEDA compliant communication channels
  • Schedule all meetings with clients in BCG software


Agree with their signature that they understand all that is in this document and that  the free counselling is time limited providing emotional and mental health support in response to COVID-19.

Client Signature:___________________

Counsellor Signature: _______________

To Download this Agreement Click Here…