Myles Sadlowski PSW, BSW
Email: myles.sadlowski.info@gmail.com
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Client Registration

Step 1 REGISTRATION
Step 2 CLIENT CONSENT
Step 3 APPOINTMENT

In a comfortable and supportive atmosphere, I offer a highly personalized approach tailored
to each of my client's individual needs to help attain the personal growth they’re striving for.

Rates & Insurance
The most important thing is to enjoy your life - to be happy - it's all that matters. -Audrey Hepburn

Client Registration

  1. Please read our Terms of Service and Privacy Policy prior to submitting your information. 
  2. Please contact me to see a full list of services and prices.

  3. Registration will likely take you at least 10 minutes. This is time well-spent because it will help you be better prepared for your Online Consultation experience.

  4. If you are experiencing a CRISIS, please click here.

  5. Completing this questionnaire will:
  • help you decide whether online consultations are suitable for you
  • help us begin to understand your situation and needs

Please note that:
  • You will also be asked to describe your concerns in your own words during the registration process.
  • All services are confidential. All records are confidential and are the property of Myles Sadlowski. 
  • There are some important exclusions to the above: 

Child welfare concerns, imminent self-harm, danger to/from others, medical emergency, subpoena or court order, professional and confidential third-party audit for quality assurance purposes.

  • Note: If you do not receive the confirmation message within a few hours of signing up, please check either your Spam or Bulk E-Mail folder just in case the confirmation email got delivered there instead of your inbox. If so, select the confirmation message and mark it Not Spam, which should allow future messages to get through.

  • Note: I'm sorry to report that insurance and state regulations may prohibit me from providing services to clients residing outside of Canada.  So if you are not currently living in Canada, please do not proceed with the Registration.

    Registration: Client Intake and Consent Form

    Personal Information

    Max file size: 20MB
    ​Please understand that all information is held in strict confidentiality. It is very important that the client builds a strong sense of trust with the practitioner. If there is anything further you would like to discuss with me before the session or any boundaries that you would like to set to ensure your comfort and relaxation, please bring these issues to my attention.
    1. I have read and understood all the information on the Myles Sadlowski website regarding the nature of this practice.

    2. I understand and accept that even though the most up-to-date technology will be used to ensure the privacy of information received by sadlowski.ca, information on the internet still cannot be absolutely secured.

    3. I realize that sadlowski.ca will never receive any of my payment information from PayPal. I take responsibility for protecting private information that I receive, generate, and store on my own computer.

    4. The law protects the relationship between a client and a Social Worker, and information cannot be disclosed without written permission. Exceptions include: 

    • Suspected child abuse or dependant adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately. 
    • If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
    • If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.
    • When subpoenaed for any information by a court of law.

    At the onset of online consultations, I agree to review the emergency resources that are available to me in my area of residence. If at any point I enter a state of crisis and am an imminent threat to myself or others, I take full responsibility for obtaining immediate and appropriate assistance as well as for any actions I may take. I understand that such situations require face-to-face intervention and accept that crisis intervention cannot be conducted online. In the event of an emergency I agree to contact at least one of the following:
    • hospital emergency room
    • a doctor
    • crisis line or agency
    • trusted adult friend or family member

    I understand that the operator of the website, Myles Sadlowski, is licensed to practice in Canada. If I reside outside of Canada, I take full responsibility for informing myself of and complying with any laws regulating whom I may seek consultations from.
    • By typing my full name below, I acknowledge that I fully understand and accept all of 
    • the above conditions. 

    Note: If you do not receive the confirmation message within a few hours of signing up, please check your Spam or Bulk E-Mail folder just in case the confirmation email got delivered there instead of your inbox. If so, select the confirmation message and mark it Not Spam, which should allow future messages to get through.
    By typing your name you consent to having read the Informed Consent and agree to the terms of the consultation
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Privacy Policy
Terms of Service
Limits of Confidentiality

Questions? Contact us by Email

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