Dr. Jake Tremblay, Registered Psychologist, CCTP

Dr. Jake Tremblay, Registered Psychologist, CCTP

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NOTE: Please read the information below each type of appointment that explains the risks and limitations associated with each type of service, before booking the appointment. If you have questions about any of services below, please call or email me to discuss them in advance of booking. Late cancellation fees are in effect. Ph: 780-907-4487 or email: jacobt@ualberta.ca

Choose a service to schedule

Telephone Counselling - $200
Billed in 15 min increments for any part thereof. TO BOOK THIS SERVICE read the information below regarding limitations, risks, benefits, and policy for Telephone Counselling, AND note that proceeding to book this appointment indicates your agreement to these same limitations, risks, benefits, and policy as outlined below.
The purposes of these psychological services are to:
a) assist with the identification and understanding of your presenting concerns through consultation, and/or assessment, treatment, or referral, and
b) to recommend an appropriate course of action to help you resolve the identified concerns.

Dr. Jake Tremblay is a registered psychologist and member of The College of Alberta Psychologists (CAP) regulating body. All information collected during these services will be done for the purposes described in a) and b) above, and will be held confidentially in accordance with Alberta legislation governing the collection and use of personal health information, and the CAP professional guidelines. Should the circumstance arise for your confidential information to be released to a third party, your explicit written consent will be required. Please note that exceptions to the confidentiality of your personal information will only be made in cases where: the safety or harm to yourself or others appears imminent; there is disclosure of imminent harm or neglect to a minor or dependent adult; your records are subpoenaed by a court of law; or you disclose a psychological workplace injury which must be reported to the Workers’ Compensation Board; or if you are considered to be a dependent minor or dependent adult, please be aware that your parent or legal guardian may have access to your confidential information. Finally, if you have been referred by a medical professional through the Imagine Health Centre, your personal health information will be stored on their electronic patient record system.
The cost for psychological services is $200.00 per hour, unless advanced arrangements have been confirmed by Dr. Tremblay. 24 hours notice is required for rescheduling or cancellation to avoid a one-hour cancellation fee. If a referral is made to an external professional or service, any costs for those services become your responsibility.
Telephone Counselling:
I give permission to Dr. Jake Tremblay, R.Psych., to use the telephone to provide me with services. I have read, understand, and agree to the Telephone Counselling: risks, benefits, limitations, and policy consent information below, which outlines the uses and risks, benefits, and limitations and policy for telephone counselling.
The permission granted by proceeding with booking this phone appointment is valid for a period of 1 year unless otherwise specified or terminated in writing.
Telephone Counselling: Uses, risks, benefits, and limitations:
Definition and Use
For the purposes of this consent, telephone counselling refers to the provision of appropriate mental health services via person-to-person, voice-only telephone call(s). It does not include services via text, email, social media, or any video-based communication service like FaceTime or Skype. One time use of email to send information that is not considered personal health information, such as resource lists or self-help information or a web link, is allowed. Telephone services will be used only when in-person meetings are prevented or prohibited due to emergency situations, such as a temporary closure of offices or quarantine due to an illness/outbreak. It is a temporary measure only, and is not becoming a regular part of how services are delivered.
Risks
The risks of this kind of service include, but may not be limited to:
(1) the security and privacy of the telecommunications link
(2) privacy of the surrounds in which the call is taking place
(3) increased distractibility due to surroundings
(4) lack of non-verbal communication cues and thereby miscommunications
(5) frustration around calls being missed, cut off, disconnected, poor connections, etc.
(6) not all forms of therapy are best served via telecommunications and may be precluded upon further exploration within the call.
Benefits
Benefits include, but may not be limited to:
(1) maintaining continuity of mental health services
(2) access to support during a time of potentially increased distress
Limitations
Limitations include, but may not be limited to:
(1) services are provided only via voice-only telephone calls
(2) session lengths, times, and flexibility may be impacted due to service needs or demands
(3) once this appointment is booked, consent is considered to be provided, and normal session limit guidelines, and the No-Show/Late Cancel policy will now resume and apply to telephone appointments
(4) disruptions of telecommunications networks cannot be predicted
Practice Guideline
Best practice guideline for this service means you agree to:
(1) allow us to contact you, and leave a voice message, to arrange times for a telephone session
(2) set a day, time, and duration of the call
(3) make yourself available and distraction free at the time of the session
(4) hold the call in a private and confidential setting and
(5) understand that not all forms of therapy and treatment are amenable to telephone counselling, and so some changes/adaptation in the kinds of support and services may be required
Video Counselling - $200
A phone or computer with a camera and mic are required. A link to the video session will be emailed to you before your appointment so that you can "check-in" a few minutes before it begins. Please ensure that you read the risks, benefits, & limitations below before proceeding to ensure you consent to this service.
INFORMED CONSENT & AUTHORIZATION FOR PSYCHOLOGICAL SERVICES
The purposes of these psychological services are to:
a) assist with the identification and understanding of your presenting concerns through consultation, and/or assessment, treatment, or referral, and
b) to recommend an appropriate course of action to help you resolve the identified concerns.

Dr. Jake Tremblay is a registered psychologist and member of The College of Alberta Psychologists (CAP) regulating body. All information collected during these services will be done for the purposes described in a) and b) above, and will be held confidentially in accordance with Alberta legislation governing the collection and use of personal health information, and the CAP professional guidelines. Should the circumstance arise for your confidential information to be released to a third party, your explicit written consent will be required. Please note that exceptions to the confidentiality of your personal information will only be made in cases where: the safety or harm to yourself or others appears imminent; there is disclosure of imminent harm or neglect to a minor or dependent adult; your records are subpoenaed by a court of law; or you disclose a psychological workplace injury which must be reported to the Workers’ Compensation Board; or if you are considered to be a dependent minor or dependent adult, please be aware that your parent or legal guardian may have access to your confidential information. Finally, if you have been referred by a medical professional through the Imagine Health Centre, your personal health information will be stored on their electronic patient record system.
The cost for psychological services is $200.00 per hour, unless advanced arrangements have been confirmed by Dr. Tremblay. 24 hours notice is required for rescheduling or cancellation to avoid a one-hour cancellation fee. If a referral is made to an external professional or service, any costs for those services become your responsibility.
VIDEO COUNSELLING:
By proceeding with booking this Video Counselling Appointment, I give permission to Dr. Jake Tremblay, R.Psych., to use video technology to provide me with psychological services. I have read, understand, and agree to the Video Counselling: Risks, Benefits, Limitations, and Consent information below, which outlines the uses and risks, benefits, and limitations and policy for Video Counselling.
The permission granted by proceeding with booking this phone appointment is valid for a period of 1 year unless otherwise specified or terminated in writing. Electronic communications will not and should not be used for medical emergencies or other time-sensitive matters.
Video Counselling Risks, Benefits, Limitations, and Consent:
Definition and Use
For the purposes of this consent, video counselling refers to the provision of appropriate mental health services via encrypted person-to-person, video and audio communication(s). It does not include services via text, email, or social media. One time use of email to send information that is not considered personal health information, such as resource lists or self-help information or a web link, is allowed. Currently, Video services will be used only when in-person meetings are prevented or prohibited due to emergency situations, such as a temporary closure of offices or quarantine due to an illness/outbreak. It is a temporary measure only, and is not becoming a regular part of how services are delivered.
Risks
While the Service Provider will use reasonable means to protect the security and confidentiality of information sent and received using electronic communications, because of the risks outlined below, the Service Provider cannot guarantee the security and confidentiality of electronic communications:
• Use of electronic communications to discuss sensitive information can increase the risk of such information being disclosed to third parties.
• Despite reasonable efforts to protect the privacy and security of electronic communication, it is not possible to completely secure the information.
• Employers and online services may have a legal right to inspect and keep electronic communications that pass through their system.
• Electronic communications can introduce malware into a computer system, and potentially damage or disrupt the computer, networks, and security settings.
• Electronic communications are subject to disruptions beyond the control of the Service Provider that may prevent the Service Provider from being able to provide services
• Electronic communications can be forwarded, intercepted, circulated, stored, or even changed without the knowledge or permission of the Service Provider or the patient.
• Even after the sender and recipient have deleted copies of electronic communications, back-up copies may exist on a computer system; however there is no intentional storage of electronic session audio or video information by the Service Provider, or the company providing the electronic video software.
• Electronic communications may be disclosed in accordance with a duty to report or a court order.
• Videoconferencing using no cost, publicly available services may be more open to interception than other forms of videoconferencing
• There may be limitations in the services that can be provided through electronic communications, dependent on the means of electronic communications being utilized
• Email, text messages, and instant messages can more easily be misdirected, resulting in increased risk of being received by unintended and unknown recipients.
• Email, text messages, and instant messages can be easier to falsify than handwritten or signed hard copies. It is not feasible to verify the true identity of the sender, or to ensure that only the recipient can read the message once it has been sent.
• Risks to privacy of the surroundings in which the call is taking place
• increased distractability due to surroundings
• lack of non-verbal communication cues and therapy miscommunications
• frustration around calls being missed, cut off, disconnected, poor connections, etc.
Benefits
Benefits include, but may not be limited to:
• maintaining continuity of mental health services
• access to support during a time of potentially increased distress
Limitations
Limitations include, but may not be limited to:
• not all forms of therapy are best served via electronic communications and may be precluded upon further exploration within the session.
• session lengths, times, and flexibility may be impacted due to service needs or demands
• once this appointment is booked, consent is considered to be provided, and normal session limit guidelines, and the No-Show/Late Cancel policy will now resume and apply to Video Counselling appointments
• disruptions of electronic communications networks cannot be predicted
• Electronic communications may be copied or recorded in full or in part and made part of your clinical chart; however neither party will record video or audio communications without the prior written consent of both the client(s), and the Psychologist.
• Prior to the commencement of the provision of services by the Service Provider through electronic communications, the Service Provider and the patient will establish an emergency protocol to address the following:
- Steps to be followed in the event of a technical issue that causes a disruption in the services that are being provided by the Service Provider; and
- Steps to be followed in the event of a medical emergency that occurs during the provision of services.
• The Service Provider is not responsible for information loss due to technical failures associated with your software or internet service provider.
• The Patient agrees to: take precautions to preserve the confidentiality of electronic communications, such as using screen savers and safeguarding computer passwords; make themselves available and distraction free at the time of the session; hold the call in a private and confidential setting
• If the Patient no longer consents to the use of electronic communications by the Service Provider, then the Patient will provide notice of the withdrawal of consent by email or other written communication.
Acknowledgement and Agreement
I acknowledge that I have read and fully understand the risks, benefits, limitations, and consent information above and understand and accept the risks as outlined.
I confirm that any questions that I had regarding the provision of healthcare services through electronic communications have been answered by the Service Provider.
If you wish to answer “yes” to this acknowledgement and agreement statement, please proceed with booking a video appointment online now. Otherwise, you may wish to book a Telephone Counselling Appointment instead, or contact Dr. Tremblay by phone or email with further questions, before proceeding.
In-Person Counselling - $200
COVID-19 RISKS & SCREENING
Please read the following before booking or maintaining your appointment. To help prevent the spread of COVID-19, please do not book an “In-person” appointment if the following applies to you:
 You have travelled internationally in the last 14 days?
 You have been in close contact and without Personal Protective Equipment (PPE) within the past 14 days with someone with a confirmed positive or presumptive diagnosis of COVID-19?
If either of these situations apply to you, you are legally required to isolate for 14 days and monitor for symptoms.
If you have displayed any of the following listed symptoms known to be related to COVID-19., currently:
 A fever
 A new or changed chronic cough
 A sore throat that is not related to a known or pre-existing condition
 A runny nose that is not related to a known or pre-existing condition
 Nasal congestion that is not related to a known or pre-existing condition
 Shortness of breath that is not related to a known or pre-existing condition
you must isolate for an additional 10 days from the beginning of symptoms or until you are feeling well, whichever takes longer.
Additional information on COVID-19 for Albertans can be found here:
https://www.alberta.ca/coronavirus-info-for-albertans.aspx
Telephone or video appointments are available in the interim if any of the above applies to you. If you have any questions about this information, I’d be happy to speak with you before you book or come to the office. Phone: 780-907-4487. By booking an In-Person Appointment to meet with Dr. Tremblay and receive Psychological Services in-person, I am aware there is a risk that I could be exposed to severe acute respiratory syndrome coronavirus 2, the virus responsible for COVID-19 (hereinafter referred to as “COVID 19”) while attending at the office to receive the services.
1. I accept and acknowledge that I could be exposed to COVID 19 through the following means (this list is not exhaustive):
a. My physical presence at the Facility;
b. My interactions with other patients or members of the public who are present at the Facility at the time of my attendance;
c. My interactions with staff, agents and other health care professionals at the Facility; and
d. The physical touching of any equipment, surfaces, or fixtures in the Facility.
2. While receiving services, Dr. Tremblay may need to be physically closer to me than the recommended social distancing guidelines in order to assess and/or treat me. By booking this appointment and by signing the Informed Consent Form at the office at the time of the appointment, I acknowledge and confirm that I am willing to accept these risks as a condition of attending in-person to receive Psychological Services from Dr. Tremblay, and that I agree to comply with the recommended COVID-19 precautions for this appointment, which include but are not limited to:
• Reviewing the COVID-19 Appointment Pre-screening Checklist at time of booking
• Completing the COVID-19 Daily Screening Checklist Form in writing at the beginning of the appointment, at the office, AND the Informed Consent and Authorization for Services form at the office
• Complying with the proper AHS precautions such as:
o using hand sanitizer upon entering & exiting the office
o wearing a Mask while in the office
o maintaining Social Distancing when possible while in the office
OR
• I agree to decline attending an appointment in-person if I am symptomatic or if any of the above screening questions apply to me.
Directions If you don't see an appointment that suits your needs, please call to discuss.
780-907-4487