Tranquility by GreenShield Health
Therapist-Assisted Digital CBT

Informed Consent

PLEASE REVIEW EVERYTHING CAREFULLY, IN PARTICULAR THE DISCLAIMER AND RELEASE SECTIONS BELOW.

TranquilityTM by GreenShield is an Internet-based Cognitive Behavioural Therapy (Digital CBT) program. Digital CBT is CBT delivered via digital platforms. In Digital CBT, the platform itself is the intervention. Digital CBT provides individuals with skills that can be used to improve their mental health and increase their quality of life.

Tranquility’s Digital CBT program aims to help return you to wellness by providing you with tools and techniques to cope with life’s challenges. CBT is one of the most established and highly effective evidence-based therapeutic models.

THERAPIST & COMMUNICATIONS.

If you choose to use Digital CBT, you will be assigned to a therapist. By using the program you hereby consent to being assigned to a therapist. 

As part of your program, therapists may message clients through a messaging function on the platform. All messaging is for Digital CBT purposes only. By using the program you hereby consent to receiving such messages by your assigned therapist. 

Confidentiality and Emergency Services.

All calls will be recorded for quality assurance purposes. All of the information you share with your Digital CBT therapist and/or within the platform is strictly confidential and will only be accessible by your therapist and Tranquility’s Clinical and Support staff, except in the following circumstances:

  • there is a serious and imminent risk of harm to you or another person, which may include situations where there is disclosed use of substances that cause impairment while working in a safety-sensitive position. Please note that after the initial 12-week period, therapists will no longer be monitoring your messages or screens for safety concerns;

  • there is suspicion that a child, (governed under the age of protection in your province), or a vulnerable or elderly person has been or is being abandoned, abused or neglected;

  • you have provided to Tranquility your consent, in writing through a signed Release of Information Form, to share with specified others, not already identified in this Informed Consent Form, information concerning your Digital CBT program;

  • disclosure as required by law; or

  • your clinician is not able to reach you after you have indicated that you are at serious and imminent risk of harm to yourself. In this case, the clinician will call your emergency contact to determine if you are safe.

In addition, your therapist will disclose information and records to Tranquility’s Clinical Services Team as needed for coordination of services, quality assurance, or payment.

PLEASE NOTE: Tranquility is not an emergency service. If you ever feel you’re in an emergency, please call 911 or go to the nearest emergency room.

Home Address.

Your therapist will ask for your home address and confirm that you are at that location at the beginning of each call. They will only use this information for emergency purposes (for example if you had a health emergency and they needed to call for help for you).

24 Hour Policy.

If you need to cancel or reschedule, please do so 24 hours before the scheduled call so that we can open that spot up for someone else to get the help they need.

DISCLAIMERS.

By signing this Informed Consent Form, to the extent permitted by applicable law, you agree that:

  1. NO MONITORING AFTER TWELVE WEEKS. AFTER THE FIRST TWELVE WEEKS OF THE PROGRAM, ALTHOUGH YOU MAY HAVE ACCESS TO THE DIGITAL CBT PLATFORM, YOU ARE USING THE DIGITAL CBT PLATFORM AT YOUR OWN RISK AS GREENSHIELD DOES NOT MONITOR ANY OF YOUR RESPONSES (EVEN IF YOU INDICATE THAT YOU ARE AT RISK OF HARMING YOURSELF OR OTHERS) OR NOTIFICATIONS, AND WILL NOT DISPATCH EMERGENCY AUTHORITIES TO YOUR LOCATION IN THE EVENT OF ANY EMERGENCY. YOU UNDERSTAND THE SCOPE, NATURE AND EXTENT OF THE RISKS INVOLVED IN YOUR CONTINUED USE OF THE DIGITAL CBT PLATFORM AND FREELY AND VOLUNTARILY ACCEPT AND ASSUME ALL SUCH RISKS, DANGERS, AND HAZARDS AND TAKE FULL RESPONSIBILITY FOR YOUR OWN ACTIONS, SAFETY AND WELFARE;

  2. YOU WILL CONTACT APPROPRIATE RESPONSE SERVICES IF YOU ARE EXPERIENCING A LIFE-THREATENING SITUATION, A SAFETY ISSUE AND/OR ANY EMERGENCY;

  3. REMOTE ACCESS RISKS TO CONFIDENTIALITY. THERE ARE RISKS TO CONFIDENTIALITY THAT MAY BE CAUSED BY HAVING REMOTE ONLINE VIDEO/PHONE DIGITAL CBT SESSIONS (INCLUDING, WITHOUT LIMITATION: (I) POOR QUALITY AUDIO-VIDEO CONNECTION; (II) DELAYS IN EVALUATION OR TREATMENT DUE TO PRODUCT FAILURE; AND (III) UNAUTHORIZED COLLECTION, USE OR DISCLOSURE OF YOUR PERSONAL INFORMATION DUE TO A SECURITY PROTOCOL BREACH OR FAILURE); 

  4. DIGITAL CBT IS NOT TO BE USED FOR EMERGENCIES OR SUICIDAL THOUGHTS OR THOUGHTS OF HARMING OTHERS. TRANQUILITY SHOULD NOT BE USED FOR MEDICAL EMERGENCIES OR IF YOU ARE HAVING SUICIDAL THOUGHTS OR ARE CONTEMPLATING HARMING YOURSELF OR OTHERS.

RELEASE.

EXEMPTION FROM LIABILITY FOR USE. TO THE EXTENT PERMITTED BY APPLICABLE LAW, YOU HEREBY REMISE, RELEASE AND FOREVER DISCHARGE GREENSHIELD, ALL OF ITS AFFILIATES AND ASSOCIATED COMPANIES, AND ALL OF THEIR RESPECTIVE AGENTS, OFFICERS, DIRECTORS, SHAREHOLDERS, EMPLOYEES, SUCCESSORS, AND ASSIGNS, (COLLECTIVELY, “RELEASED PARTIES”), FROM ALL LIABILITY, ACTIONS, CAUSES OF ACTION, CLAIMS AND DEMANDS OF EVERY NATURE WHICH MAY HAVE BEEN, ARE BEING OR MAY BE MADE OR ASSERTED WITH RESPECT TO, ARISING OUT OF OR  IN ANY WAY CONNECTED WITH YOUR ACCESS TO TRANQUILITY. THIS EXEMPTION FROM LIABILITY ALSO INCLUDES LOSS, DAMAGE OR INJURY RESULTING FROM THE NEGLIGENCE OF THE RELEASED PARTIES.

By signing this Informed Consent Form, you acknowledge that you are attending the Digital CBT training program of your own accord and that you understand that you are free to end the program anytime you wish.

By signing this Informed Consent Form, you understand all of the information contained in it and accept it as the terms and conditions of your participation in Tranquility’s Digital CBT program (in addition to the Terms & Conditions, as defined below).

By signing this Informed Consent Form, you understand that these terms are intended to supplement (and are not a replacement for) GreenShield’s terms and conditions (accessible here: INSERT HYPERLINK), which may be replaced or amended from time to time (the “Terms & Conditions”). In the event of a conflict between the terms in this Informed Consent Form and the Terms & Conditions, this Informed Consent Form prevails to the extent of the conflict.

You may revoke your consent at any time with oral and written notice to Tranquility by GreenShield’s Clinical Services Team. If you do not revoke this consent, this consent will expire one (1) year after the date of this authorization.

INDEPENDENT LEGAL ADVICE. 

YOU AGREE THAT YOU HAVE READ AND UNDERSTOOD THE CONTENTS OF THIS INFORMED CONSENT FORM (INCLUDING, WITHOUT LIMITATION, THE DISCLAIMERS AND RELEASE). YOU HAVE BEEN GIVEN AN OPPORTUNITY TO OBTAIN INDEPENDENT LEGAL ADVICE CONCERNING THE INTERPRETATION AND EFFECT OF THIS INFORMED CONSENT FORM. IN THE EVENT THAT YOU HAVE CLICKED ‘ACCEPT’ TO THE INFORMED CONSENT FORM WITHOUT THE BENEFIT OF INDEPENDENT LEGAL ADVICE, YOU HEREBY WAIVE THE RIGHT TO RELY ON ANY ARGUMENT THAT YOU DID NOT RECEIVE INDEPENDENT LEGAL ADVICE.

By checking this button, I consent to the information provided above, and will be deemed to have signed this Informed Consent Form.