Practice Consult Request Form

Contact Information

First Name

Last Name

RSW Certficate #

Positon Title

Organization Name

Street Address

City

Province/Territory

Postal Code

Primary Telephone

Secondary Telephone

Consultation Details

Descripton of ethical issue or queston. Steps already taken to resolve ethical issue or question.

Requested timeframe for consultation (Note that consultations are generally scheduled in the order in which they are received, considering the assessed urgency of the situation.

Preferred time of day to schedule a consultation appointment

Select all that apply:

Morning

Afternoon

Evening

Preferred appointment duration

30 minutes

60 minutes

Declaration and Signature

A consultation is a process to support Social Workers in identifying, analyzing and resolving ethical or practice dilemmas guided by the Social Work Profession Act and the MCSW Code of Ethics and Standards of Practice.

Social Workers are responsible for their own practice decisions. A consultation is not designed to provide solutions to an ethical dilemma or practice issue or make specific recommendations/decisions on behalf of Social Workers. An ethical consultation is not a substitute for legal advice.

All consultations are documented, and a consultation record is kept securely at the MCSW office. These records allow MCSW to monitor ethical issues and trends.

Date

Signature (please type full name)