Consent for Service combined form

I agree to one or more of the following online/distance services with Lorri Yasenik Counselling, and Consulting Ltd. Registration #1432 via the Internet or Telephone Services.

I agree the service will be provided to:

Please list first & last names

Please read the following important information.  By clicking on the "next page" element you are indicating that you have read, understood, and agreed to the following  information.

  • About Online Video Sessions:
  1. Video sessions are utilized when in-office sessions are not convenient or possible, and only at the client’s request.
  2. Video Sessions can occur by telephone, tablet or computer. Sessions make use of proprietary software including:
    • Apple FaceTime
    • Zoom Meetings
    • Skype and Skype for Business OR
    • Equivalent Software Products