Back to the main BCACC website Staff submission Add the basic information for offline submissions so that we can create the case # for offline submissions. "*" indicates required fields Step 1 of 5 20% URLThis field is for validation purposes and should be left unchanged.Is this a manual Staff submission? Yes Date receivedComplainants Name:Is there any extra information to include?Before you get started, please check out what we can investigate >>Getting StartedThe form has 5 sections, each with a series of questions. After completing each section, click "Next" to proceed. If you need to pause, click "Save and Continue Later." You’ll receive a unique link to your partial submission, which you can also have emailed to you. This link is valid for up to 25 days. The sections of this form are: A. Person registering the complaint B. Client/Complainant information C. Details of complaint D. Supporting documents E. Authorization Please note: Section B is only applicable if you are filing a complaint for another person, Important first step:BCACC can only investigate complaints of BCACC Members (RCCs), so you must verify that the counsellor/RCC is actually a member of the BCACC. You can find whether a counsellor is a registrant of the BCACC by searching the counsellor’s name or RCC number in our Member Registry. Access the BCACC Member Registry via this link: BCACC Member’s Registry Once you have searched the Member Registry, please select one of the following:* I have the BCACC Member (RCC) Membership # and I'll place it into the box below I cannot find the counsellor in the BCACC Registry If you are unable to find your counsellor in the Registry but think they are a BCACC member (RCC) please contact the Head Office at 250-595-4448/1-800-909-6303 for assistance. Details of the BCACC member (RCC) who is the subject of the complaintWe do not take complaints about businesses, only individual RCCs.BCACC Member (RCC) - Membership #:*BCACC Member (RCC) - First and Last Name: * First Last This field is hidden when viewing the formNext Steps: Sync an Email Add-OnTo get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form. A. Your InformationYour Name* First Last Pronouns:Your Address Street Address City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Preferred Method of ContactEmailPhoneYour Email Address* Email Address Confirm Email Address Your Preferred Phone #*Do you need any accommodations in submitting a formal complaint?* Yes No Please explain the accommodations you need:*I confirm that I am 12 years of age or older.* Yes No Parent/Guardian InformationParent/Guardian Name* First Last Parent/Guardian Email Address* Email Address Confirm Email Address Parent/Guardian Phone Number*This field is hidden when viewing the formAre you the client of the counsellor? Y/N* Yes No Please select one of the following:* I am the legal guardian and/or someone who has power of attorney for the client I am a clinical professional Other Please describe your connection:*B. Complainant’s InformationIMPORTANT: Only complete if you are not the recipient of the counselling services. Client Information: Complainant #1 Client’s Full Name:* First Last Client's Preferred Phone #*Client's Address Street Address City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Date of Birth (if client was under the age of 19 at the time of counselling): MM slash DD slash YYYY This field is hidden when viewing the formIs there more than one client/complainant?NoYes - there are two complainantsClient Information: Complainant #2Client #2 Full Name:* First Last Client #2 Date of Birth (if client was under the age of 19 at the time of counselling): MM slash DD slash YYYY Client #2 Preferred Phone Number*Does Client #2 have a different address? Yes Client #2 Address Street Address City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code This field is hidden when viewing the formSection BreakIs this complaint related to couples counselling or family counselling? Y/N* Yes No Please explain the connection*C. Other Party InformationThe name of the other party*Email of the other party*Phone Number of the other party*Release of information from the other party*All parties involved in the counselling sessions are required to sign a release of information prior to formal submission being sent. If you are unable to obtain a signature please note they must sign the release PRIOR to the complaint moving forward. If it is not possible for you to obtain their signature, indicate below and a release form will be sent to them. Yes, as the other party I authorize the release of information As the main complainant, I am unable to obtain consent at this time. Please send me the consent form by email so that I can forward it to the other parties involved. Signature of the other party* C. Details of complaintWhat was the approximate date and year of the incident giving rise to the complaint* MM slash DD slash YYYY Please read through all questions prior to answering There is a maximum of 5000 characters (approximately 850 words) for each question below.1. What was the purpose of the counselling?*2. What did the BCACC Member (RCC) do (or fail to do) to cause your concern?*3. Other parties or witnesses connected to this complaint (please explain connection and provide contact information)*4. Please describe any attempt(s) you may have made to address your concerns with the BCACC Member (RCC).*5. Please provide a timeline of the events relating to this complaint and include dates wherever possible. Exact dates are preferred but approximate dates are acceptable.*6. Please describe what a resolution might look like for you. Please note that there are limitations to what BCACC can do.*The BCACC does not compel members to issue written apologies, as mandated apologies have not been valued by former complainants. Check out what we can investigate >7. Have you filed a complaint with anyone else, retained an attorney, or has the case been reviewed by any experts? No Yes 7a. If yes, please provide detailed information.*8. Are there any current legal proceedings related to this complaint? No Yes 8a. Legal QuestionaireBecause you have indicated "Yes", that there are current legal proceedings, please fill out this legal questionnaire. If these series of questions below do not apply to your situation, you should inform us and disregard this section. However, if they do apply to your situation, please provide answers to them along with the requested supporting documents. Failure to answer questions. Failure to answer the questions below or to provide the requested supporting documents may then lead the Committee to refuse to investigate the complaint further and close the file. In such circumstances, you would be informed of that outcome. The following list of questions should be addressed if: The counsellor in question has provided, is providing or will be providing written input in a legal proceeding in which you have been, are or will be involved. Some of these questions may not be applicable in all circumstances. You may need to consult with your legal counsel before answering every question. Please provide answers and supporting documentation in writing.Questions1. What was the source of the letter/report?For example, was the counsellor’s document prepared pursuant to the Family Law Act? If so, what specific section of the Act? Or was it prepared pursuant to some other statute? Was the counsellor asked to prepare the document with the agreement of the parents? Or was it prepared at the sole request of one parent or some other party?2. Did the court consider it?Whether or not the counsellor’s letter/report was prepared pursuant to the Family Law Act, did the court consider it before it issued an order pursuant to the Act? Or before it issued any other order under another Act? Or was it used by either or both of the parties leading to an agreement under the Act.3. Was the court critical of the counsellor’s filed letter/report?Did the court reject any specific finding or recommendation? What specific facts as set out in the letter/report were either accepted or rejected by the court? Were any recommendations in the document adopted or rejected by the court? Please provide details.4. Was the author of the letter/report cross-examined or challenged in court before the court issued its order based on that document?If the author was cross-examined or challenged, on what specific issue(s) was the author so examined or challenged? And why did any such challenge not succeed? If a cross-examination of the author was not undertaken or a challenge was not made, why did this not take place?5. Was another professional hired to review or critique the counsellor’s document or to prepare a separate report?Was that other report or was the other professional presented as a witness, before the court issued its order? If such third-party review was undertaken, why did it not succeed? If such a review was not undertaken, why was it not pursued?6. Has a request for a review or an appeal of some sort been initiated to change the court order?Whether or not the court considered the counsellor’s letter/report before issuing its order, has a request for a review or an appeal of some sort been initiated to change the court order? If such a review or appeal was made, why did it not succeed? If a review or appeal was not initiated, why was this option not pursued? If such a review will be made in the future, when will the court consider this matter? D. Supporting documentsPlease attach copies of documentation specific to this complaint. This may include things like: relevant reports, court orders, correspondence (written letters, PDFs of emails, text messages etc.), photographs and/or any other written materials you deem relevant. You can add up to 5 documents. These materials will aid the BCACC in its review of your complaint. Important Notice Regarding Privileged InformationI agree that I have read and understand the information below.*In submitting this complaint, please ensure you do not include the following types of records: Records of communications with your own legal counsel as such information is subject to solicitor client privilege and disclosing that information can be considered waiver of privilege; Records obtained in the discovery process in litigation as such records are subject to an implied undertaking that they can only be used for the purposes of that litigation unless a court orders otherwise; Records that would reveal trade secrets or proprietary business information; Records containing information subject to privilege or obtained in the litigation process cannot be considered as part of the complaint review process. Yes, I agree File Drop files here or Select files Accepted file types: jpg, jpeg, gif, pdf, doc, Max. file size: 64 MB, Max. files: 5. Please specify how each relates to your concerns.Do you wish to provide audio or video recordings? Yes If you wish to provide audio or video recordings, we will contact you later in the process. E. Authorization – please read carefully1. The Sharing of information*I understand that any relevant information generated in the investigation process will also be shared with the BCACC Member (RCC) to ensure that they adequately understand the full nature of the complaint and have an opportunity to respond. I give the BC Association of Clinical Counsellors (BCACC) permission to release a copy of my complaint and supporting documents submitted with my complaint to the BCACC Member (RCC) named in this complaint, in order for the BCACC to obtain their response. This consent for release of information also extends to the BCACC Member's (RCCs) clinical supervisor(s) and/or their legal counsel. I also understand that BCACC Member (RCC) may be required to provide the complaint information to their insurers. Yes, I understand the sharing of information. 2. Release of information*I authorize the BCACC Member (RCC) to release to the BCACC any information relating to the services provided, including any documentation in their practice records relating to these services. I understand that such information will be used in the investigation of my complaint and will be provided to the Office of the Registrar, and the Inquiry Committee for their consideration of this matter. Yes, I authorize the release of information 3. Confidentiality of Materials*BCACC considers the complaint form and supporting documents, Investigator’s Report, and all other complaint related materials gathered or created during the complaint and investigation process to be confidential and intended solely for use within BCACC’s complaint process. BCACC does not consent to the use of these materials in any other proceeding. Yes, I understand BCACC does not consent to the use of these materials in any other proceeding. 4. All Statements are true.*I confirm that all statements made by me related to this complaint are true to the best of my knowledge and belief. Yes, I confirm that all statements are true Signature of Complainant:*Signature of Complainant #2Case NumberSince this is a staff submission, there is no authorization required. Press the submit button below to log this entry and to get the case number.