Consent Form
Provider: Rena Marie Guidry
Purpose and scope
I, Rena Marie Guidry, provide informal mentoring, guidance, and educational support. I am not providing psychotherapy, counselling, clinical treatment, diagnosis, medical care, or any other healthcare service through this arrangement. I may offer non-clinical support focused on general wellbeing, communication, routines, study habits, confidence, goal-setting, life skills, and practical parenting strategies.
What this support is not
I understand and confirm that:
-
This support is informal mentoring only and is not a substitute for therapy, counselling, medical care, psychiatric care, diagnosis, or treatment.
-
No clinical, therapeutic, medical, or healthcare relationship is created through this mentoring arrangement.
-
If concerns arise that may require mental-health, medical, therapeutic, safeguarding, or emergency support, I may pause or end mentoring and recommend that the parent/guardian contact an appropriate qualified professional or emergency service.
-
In an emergency in Portugal, call 112.
Safeguarding and privacy
I will handle personal information in line with the applicable Privacy Notice and data-protection rules. I collect only information reasonably necessary to provide and administer mentoring.
*When working with minors, I cannot promise absolute confidentiality. I may need to share information where I reasonably believe this is necessary to protect a young person or another person from serious harm, where there is a safeguarding concern, where disclosure is required by law, or where emergency support is needed. Where appropriate and safe, I will aim to discuss this with the parent/guardian and young person first.
Client acknowledgement
I understand that I am requesting informal mentoring only, not therapy or clinical treatment. I have read and agree to this agreement and have read the linked Privacy Notice.
*I, the undersigned, confirm that I am the parent, legal guardian, or person with legal responsibility for the young person below.