ONTARIO REGISTERED PSYCHOTHERAPISTS DISCIPLINE TRIBUNAL

Date: August 25, 2025

Tribunal File No.: 24-011-RP

BETWEEN:

College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario

College

• and -

Justin La Rose

Registrant

FINDING AND PENALTY REASONS

Heard: July 18, 2025, by videoconference

Panel:

Raj Anand (panel chair)

Miranda Monastero (registered psychotherapist)

Henry Pateman (public)

Radhika Sundar (registered psychotherapist)

Jeffrey Vincent (public)

Appearances:

Emily Graham, for the College

Lisa Hamilton, for the registrant

RESTRICTION ON PUBLICATION

Pursuant to Rule 2.2.2 of the HPDT Rules of Procedure and ss. 45-47 of the Health Professions Procedural Code, no one shall publish or broadcast the names of clients or any information that could identify clients or disclose clients’ personal health information or health records referred to at a hearing or in any documents filed with the Tribunal. There may be significant fines for breaching this restriction.

The Ontario Registered Psychotherapists Discipline Tribunal is the Discipline Committee established under the Health Professions Procedural Code.

Introduction

1During a therapy session with the registrant Justin La Rose in January 2023, Client A alleged that he had experienced specific acts of sexual abuse by a registered massage therapist (RMT) that month. Mr. La Rose was aware of his obligation as a registered health professional to report the alleged sexual abuse to the College of Massage Therapists of Ontario (CMTO), and he advised Client A of this.

2The registrant in fact contacted the CMTO about his reporting obligations, and he accessed the CMTO website, but he did not file a report. Separately, Client A informed the CMTO that he had experienced sexual abuse by a registrant in early January 2023, and that he had informed Mr. La Rose. Client A was seeking the registrant’s support and expected him to make the mandatory report.

3For the next several months, with increasing urgency, both Client A and the CMTO repeatedly asked the registrant to file the mandatory sexual abuse report with the CMTO. Mr. La Rose failed to respond to either of them, and Client A ultimately went to a new therapist after the registrant cancelled his appointment on July 31, 2023.

4The parties presented an agreed statement of facts in which the registrant admitted professional misconduct because of his failure to report the alleged sexual abuse, and his failure to respond to his client and the CMTO when they asked him many times to do so.

5After making a finding of professional misconduct, we received the parties’ joint submission on penalty and costs. They referred to the registrant’s prior discipline in 2021 for somewhat similar misconduct, as well as evidence about some health issues that were present when Mr. La Rose failed to act in the face of clear ethical obligations.

6We made the order requested by the parties, which included the delivery of a reprimand, and the imposition of a one-month suspension as well as extensive remedial terms, including therapy, record-keeping, and clinical supervision that were designed to achieve rehabilitation, compliance with Mr. La Rose’s practice obligations, and protection of the public.

7These are our reasons.

Professional misconduct

8Mr. La Rose has been a registrant of the College of Registered Psychotherapists of Ontario and Registered Mental Health Therapists of Ontario (CRPO) since April 10, 2018. He treated Client A between September 2022 and May 2023.

9In January 2023, during a therapy session, Client A disclosed to the registrant that he had been sexually abused by an RMT. The registrant asked Client A to discuss in detail what happened. Client A disclosed the name of the RMT and the specific sexual acts that allegedly took place.

10The registrant was aware, and he advised Client A, that as a regulated health professional, he had an obligation to report the alleged sexual abuse to the CMTO, pursuant to s. 85.1 of the Health Professions Procedural Code (Code), Schedule 2 to the Regulated Health Professions Act, 1991, SO 1991, c. 18.

11Mr. La Rose contacted the CMTO about his mandatory reporting obligation. He also accessed the CMTO’s website with the intention of filing the mandatory report. While he subjectively believed that he had submitted a mandatory report to the CMTO, the parties agree that his understanding was not objectively reasonable, and that he failed to comply with s. 85.1 of the Code.

12Over the next several months, both the CMTO and the client made repeated requests to the registrant to make the mandatory report to the CMTO. There was little or no response from Mr. La Rose.

13On March 21, 2023, Client A provided information to the CMTO about the allegations of sexual abuse by a member of the CMTO in early January 2023. Client A indicated that he had disclosed these sexual abuse allegations to the registrant after they occurred. The CMTO asked Client A for his therapist’s name and contact information.

14On April 25, 2023, Client A emailed the CMTO, copying the registrant, and asked him to provide the report to the CMTO. Because he subjectively believed that he had filed the report, Mr. La Rose believed Client A was mistaken. However, the registrant did not respond, and did not try to correct Client A.

15On April 27 and May 1, 2023, the CMTO sent emails to the registrant, reminding him of his mandatory reporting obligations, and on May 5, the CMTO called and left him a voicemail. Mr. La Rose did not respond to any of these contacts.

16On May 11 and May 18, 2023, Client A followed up with the registrant by email. Again, the registrant did not respond.

17On May 19, 2023, the CMTO sent another email to the registrant, setting a June 2, 2023 deadline for Mr. La Rose to file a mandatory report with the CMTO or explain why he was not required to do so. If he did not respond, the CMTO would make a report to the CRPO. The registrant did not respond, nor did he file the mandatory report.

18On June 3 and 7, 2023, Client A again followed up, and there was no response from the registrant.

19The client then booked a therapy session with the registrant for July 31, 2023, to discuss the CMTO matter.

20That morning, the registrant was both sick and overwhelmed with his responsibilities relating to an ailing family member. Mr. La Rose sent Client A an email postponing the appointment due to sickness. The client replied that he only wanted to speak for five minutes, and that he was disappointed in the registrant’s failure to respond.

21The registrant did not respond further and did not reschedule the appointment. This was the last time Client A heard from Mr. La Rose.

22Client A was distressed and frustrated by the registrant’s lack of responsiveness. He was worried that his complaint to the CMTO would not be able to proceed if the registrant failed to make the mandatory report. Client A felt hung out to dry, but he put up with it because the registrant had been helping him so much and because he trusted the registrant. Ultimately, Client A had to find a new therapist.

Analysis

23The registrant’s actions and inaction over this period in 2023 constituted professional misconduct under s. 51(1)(c) of the Code and under several paragraphs of s. 1 of Ontario Regulation 317/12 made under the Psychotherapy Act, 2007, SO 2007, c. 10, Sched. R.

24Mr. La Rose admitted that he failed to maintain a standard of practice of the profession under para. 1 of the Regulation, and contravened a provision of the Code under para. 42 of the Regulation, when he failed to file a report with a health regulatory College (in this case, the CMTO) despite having reasonable grounds to believe that a member of that College had sexually abused a client (in this case, Client A). The CRPO’s Professional Practice Standard 1.3 – Mandatory Reporting reflecting s. 85.1(1)(a) of the Code, confirms every CRPO member’s obligation to make a report in those circumstances. The registrant breached both provisions.

25The registrant’s persistent failure to respond to a vulnerable client’s pleas to file the report with the CMTO was psychologically or emotionally abusive toward Client A, in contravention of para. 2 of the Regulation. The client was depending on Mr. La Rose for support in seeking some redress in response to the actions of the RMT, and felt “hung out to dry” because the registrant’s repeated non-response and inaction betrayed the trust he had placed in Mr. La Rose.

26As a regulated health professional, Mr. La Rose evidently had a duty to cooperate with and respond to appropriate direction from another College about filing the mandatory report. The registrant also had a duty to reply to his client’s ongoing requests to meet a basic standard of diligence in carrying out another straightforward professional duty by filing the report. Together, the registrant’s failure to respond to both his regulator and his client, and his mistreatment of a vulnerable client, would reasonably be regarded by members of his profession as disgraceful, dishonourable or unprofessional conduct under para. 52 of the Regulation. It was also conduct that would reasonably be regarded by CRPO members as conduct unbecoming a member of the profession under para. 53 of the Regulation.

Penalty and costs

27Where the parties arrive at a joint submission on the appropriate penalty, the panel is required to accept it unless the proposed penalty would bring the administration of justice into disrepute and is so unhinged from the circumstances of the case that it must be rejected: R. v. Anthony Cook, 2016 SCC 43; Bradley v. Ontario College of Teachers, 2021 ONSC 2303 (Div. Ct.).

28Applying this test, we are not prepared to depart from the parties’ joint submission. The detailed order provided by the parties appropriately balances the well-established penalty goals of protection of the public, general and specific deterrence, rehabilitation and promoting confidence in self-regulation of the profession by the College.

29The order also falls well within the range and type of penalties that have been ordered by the Tribunal in similar circumstances. We recognize that each case is based on its unique set of facts, and of course decisions generally have less precedential value where the panel has a limited role in assessing a joint submission. Nonetheless, the cases submitted by the College have features that are worth noting.

30In College of Nurses of Ontario v. Wilcox, 2012 CanLII 100001, the Discipline Committee accepted the parties’ joint submission and ordered a reprimand as well as several educational and rehabilitative measures. The registrant believed subjectively that a patient’s complaint about another nurse was not about sexual abuse, but about the manner in which the other nurse performed a procedure. The parties agreed that the registrant was obliged to elicit further information from the patient to clarify the nature of her concerns. Unlike Mr. La Rose, Ms. Wilcox did not take steps to obtain the necessary information. But in both cases, they failed to file a mandatory report of alleged sexual abuse.

31While Ms. Wilcox had no discipline history, Mr. La Rose has a prior finding of professional misconduct in 2021 as a result of misconduct that was similar in some ways to the case before our panel. In 2018 and 2019, the registrant failed on multiple occasions to complete treatment notes, file them in the client records and deliver them to the registrant’s supervising psychologist, who had overall responsibility for the care of clients and the custody of their records.

32College of Psychologists of Ontario v. Schnayer, 2019 ONCPD 2 involved a registrant who failed to report allegations of sexual and physical abuse by a parent to a Children’s Aid Society, contrary to his statutory obligations. Despite receiving this information on an ongoing basis for seven years, the psychologist believed there was no need to report, because the Children’s Aid Society was already involved with the family. In fact, it was unaware of alleged sexual abuse. In a split decision, the majority ordered a two-month suspension, while the minority would have directed a conditional suspension of one month.

33The third case provided to us is a decision of this tribunal (then known as the Discipline Committee) in 2023 that also involved the obligation to protect vulnerable children by reporting their parents’ alleged abuse. In College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario v. Muscat, 2023 ONCRPO 5, the registrant failed to report to the Children’s Aid Society, in three separate instances, fathers whose conduct presented a risk of harm to children. On a joint submission, the panel ordered a two-month suspension as well as education and practice monitoring.

34The basic non-compliance by Mr. La Rose consisted of the failure to file a mandatory report, and the failure to respond to the entreaties of a desperate client and to a regulator that was fulfilling its mandate to protect the public interest. The registrant’s ethical obligations to his client and the two regulators were clear. Non-cooperation of this kind is serious, but the registrant has acknowledged his misconduct, reduced the costs and inconvenience to the parties, and obviated the need for witnesses, particularly the vulnerable client, to testify.

35There are other mitigating factors. The evidence indicates that medical and psychological factors may have contributed to the registrant’s misconduct. He has been under the care and treatment of a registered psychotherapist since February 2022 for severe avoidance issues and ADHD, both of which interfere with his capacity to communicate in a timely manner. These tendencies are exacerbated in situations that concern authority figures such as the supervising psychologist in 2018 and 2019, and the CMTO in 2023. In the events that led to this panel’s hearing, Mr. La Rose was also under stress because he was tending to a close family member who was facing a terminal illness.

36The parties’ agreed penalty attempts to address the psychological and avoidance issues through therapy and practice improvements. The goal is to prevent another failure or refusal on his part to meet some of the most basic professional obligations. The proposed order involves a multi-faceted set of remedial measures, to be monitored by the College and a clinical supervisor, including

a. Therapy with a mental health professional for at least six months;

b. Maintenance of a log of requests made to him in his professional capacity for responses;

c. Engagement of a clinical supervisor to assist with office administration and practice management for at least 12 months;

d. Completion of specific professional education;

e. Reassessment of his practice six months after completion of the clinical supervision;

f. Hiring of an administrative assistant;

g. A restriction on his practice to limit clinical interactions to one client per hour, and no more than six hours per day; and

h. Consent and cooperation with monitoring including unannounced inspections and inquiries to third parties.

37We accepted the parties’ agreement that the registrant will pay the tariff amount of $6,055 in costs within one month.

Order

38We therefore ordered:

Penalty

1. The Tribunal requires the registrant to appear before the panel to be reprimanded.

2. The Tribunal directs the Registrar to:

a. suspend the registrant’s certificate of registration for one (1) month commencing on July 19, 2025 at 12:01 a.m.

b. place the following terms, conditions and limitations on the registrant’s certificate of registration, effective immediately:

Therapy:

i. Mr. La Rose shall engage in therapy with a College-approved mental health professional, who shall provide written reports to the College on a quarterly basis or more frequently if Mr. La Rose’s mental health professional has concerns that Mr. La Rose’s clients may be at risk of harm or injury or that Mr. La Rose has failed to attend for appointments without sound reason;

ii. Mr. La Rose shall provide his mental health professional with a copy of this Order and the Discipline Tribunal’s Reasons for Decision;

iii. Mr. La Rose shall meet with his mental health professional once every week for a minimum of six (6) months from the date of this Order;

iv. After the first six (6) months from the date of this Order, the frequency of Mr. La Rose’s appointments with his mental health professional will be reviewed by his mental health professional, and may be decreased with the approval of his mental health professional and the College;

v. The frequency of Mr. La Rose’s appointments with his mental health professional will never be less than once per month;

vi. Mr. La Rose shall comply with all treatment recommendations of his mental health professional;

Log:

vii. For a period of twenty-four (24) months commencing on the date Mr. La Rose resumes practice following the suspension of his certificate of registration, Mr. La Rose shall maintain a log of all requests for responses he receives in his professional capacity from clients and third-parties (for example, from professional regulatory bodies, government agencies, insurance companies, other health-care providers, child and family services, and law enforcement), which shall include a copy of the requests received, the date such requests were received, and the date of Mr. La Rose’s response (the “Log”). Mr. La Rose shall also include a copy of the request and his response in the relevant client’s clinical record;

viii. Mr. La Rose shall submit a copy of the Log to the College at the end of every month, for a period of twenty-four (24) months;

Clinical Supervision:

ix. Prior to resuming practice after the suspension of his certificate of registration, Mr. La Rose shall retain at his own expense, a clinical supervisor acceptable to the College (the “Clinical Supervisor”) with respect to practice management, including but not limited to effective office administration and timely responses to requests for responses from clients and third-parties, as well as compliance with mandatory reporting requirements. The Clinical Supervisor will execute an undertaking in the form attached at Schedule “A”;

x. For a period of twelve (12) months commencing on the date Mr. La Rose resumes practice following the suspension of his certificate of registration, Mr. La Rose will practise only in accordance with the terms of the Clinical Supervision set out herein and in Schedule “A”;

xi. For a minimum of six (6) months (“Medium-Level Supervision”), the Clinical Supervisor shall:

1. Meet with Mr. La Rose every two (2) weeks;

2. Review the Log and related correspondence, including the requests received, the responses by Mr. La Rose and the associated records and client charts to ensure appropriate documentation. The Clinical Supervisor may conduct an additional review of any records or documents deemed necessary for the purposes of the Clinical Supervision. The Clinical Supervisor may also make inquiries of relevant individuals, including staff or colleagues;

3. Review a minimum of ten (10) client charts, to be selected in the Clinical Supervisor’s sole discretion, and review and comment on any issues or concerns arising from this review, including but not limited to Mr. La Rose’s practice management and compliance with mandatory reporting;

4. Keep a log of all clients whose charts were reviewed, along with client identifier; and

5. Make recommendations to Mr. La Rose for any practice improvements and ongoing professional development, and inquire as to Mr. La Rose’s compliance with the recommendations;

xii. After a minimum of six (6) months of Medium-Level Supervision, and if recommended by the Clinical Supervisor and approved by the College in its sole discretion, Mr. La Rose may practice under Low-Level Supervision for an additional six (6) months. During Low-Level Supervision, the Clinical Supervisor shall:

1. Meet with Mr. La Rose every month;

2. Review the Log and related correspondence, including the requests received, the responses by Mr. La Rose and the associated records and client charts to ensure appropriate documentation. The Clinical Supervisor may conduct an additional review of any records or documents deemed necessary for the purposes of the Clinical Supervision. The Clinical Supervisor may also make inquiries of relevant individuals, including staff or colleagues;

3. Review a minimum of ten (10) client charts, to be selected in the Clinical Supervisor’s sole discretion, and review and comment on any issues or concerns arising from this review, including but not limited to Mr. La Rose’s practice management and compliance with mandatory reporting;

4. Keep a log of all clients whose charts were reviewed, along with client identifier; and

5. Make recommendations to Mr. La Rose for any practice improvements and ongoing professional development, and inquire as to Mr. La Rose’s compliance with the recommendations;

xiii. Mr. La Rose shall abide by the recommendations of the Clinical Supervisor, including but not limited to, any recommended practice improvements and ongoing professional development;

xiv. The Clinical Supervisor’s reports shall be in reasonable detail, and shall contain all information the Clinical Supervisor believes might assist the College in evaluating Mr. La Rose’s standard of practice and conduct, as well as Mr. La Rose’s participation in and compliance with the requirements set out in this Order;

xv. If Mr. La Rose is unable to obtain a Clinical Supervisor in accordance with this Order, he will cease to practice until such time as he has done so. Any periods during which Mr. La Rose does not have a Clinical Supervisor do not count towards the requirement that he practice under Clinical Supervision for a period of twelve (12) months;

Professional Education:

xvi. Within six (6) months of the date of this Order, Mr. La Rose shall enroll in and successfully complete instruction, courses and/or self-education acceptable to the College in its sole discretion in the following topics (“Professional Education”):

1. practice management; and

2. the safe and effective use of self;

xvii. Mr. La Rose shall provide the College with proof of his successful completion of the Professional Education, including proof of registration and attendance and participant assessment reports, within one (1) month of completing them;

Reassessment:

xviii. Approximately six (6) months after the completion of the Clinical Supervision set out above and Schedule “A” to this Order, and the Professional Education set out above, Mr. La Rose will submit to a reassessment of his practice with regard to practice management and mandatory reporting (“the Reassessment”) by an assessor or assessors selected by the College (the “Assessor” or “Assessors”);

xix. The reassessment may include, at the College’s discretion, a review of Mr. La Rose’s Log and related documentation; an interview with Mr. La Rose, interviews with colleagues and staff, and any other tools deemed necessary by the College;

xx. The results of this assessment shall be reported to the College;

xxi. Mr. La Rose shall abide by all recommendations with regard to practice management and compliance with mandatory reporting obligations made by the College-appointed Assessor;

Administrative Support:

xxii. Mr. La Rose shall retain and employ an administrative assistant at every location at which he practices, including, but not limited to any clinics, offices, and/or hospitals with which he is affiliated, in any jurisdiction (collectively his “Practice Location” or “Practice Locations”);

Practice Restriction:

xxiii. Mr. La Rose shall have clinical interactions for no more than six (6) hours per day, at a rate of no more than one (1) client per hour;

Monitoring and Other Terms:

xxiv. Within five (5) days of this Order, Mr. La Rose shall inform the College of each of his Practice Locations. Going forward, he shall inform the College of any and all new Practice Locations within five (5) days of commencing practice at that location;

xxv. Mr. La Rose shall cooperate, and shall not interfere, with unannounced inspections of his practice by the College and any other activity the College deems necessary for the purpose of monitoring Mr. La Rose’s compliance with the terms of this Order;

xxvi. Mr. La Rose shall provide the College with his irrevocable consent to make enquiries of any person(s) or institution(s) that may have relevant information, in order for the College to monitor his compliance with the terms of this Order; and

xxvii. Mr. La Rose shall be responsible for any and all costs associated with implementing the terms of this Order.

Costs

3. The Tribunal requires the registrant to pay the College costs in the amount of $6,055 by August 18, 2025.

SCHEDULE “A” TO THE

ORDER OF THE ONTARIO REGISTERED PSYCHOTHERAPISTS DISCIPLINE TRIBUNAL

RE: JUSTIN LA ROSE

(“Mr. La Rose”)

1. I am a practising member of the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario (the “College”), certificate number _______________________.

2. I have read the Decision and Reasons for Decision of the Ontario Registered Psychotherapists Discipline Tribunal (“Discipline Tribunal”) dated ______________ regarding Mr. La Rose. I understand the concerns regarding Mr. La Rose’s practice management, including but not limited to effective office administration and timely responses to requests for responses from clients and third-parties, as well as his compliance with mandatory reporting requirements.

3. I agree that, commencing on the date I sign this Undertaking, I shall act as Clinical Supervisor for Mr. La Rose for a period of twelve (12) months. My obligations as Clinical Supervisor shall include, at a minimum:

a. For a minimum of six (6) months, I will provide Medium-Level Supervision to Mr. La Rose, as set out in the Discipline Tribunal’s Order dated July 18, 2025 (“the Order”). During the period of Medium-Level Supervision, I will:

i. Meet with Mr. La Rose every two (2) weeks;

ii. Review the Log Mr. La Rose is required to maintain and related correspondence, including the requests received, the responses by Mr. La Rose and the associated records and client charts to ensure appropriate documentation. The Clinical Supervisor may conduct an additional review of any records or documents deemed necessary for the purposes of the Clinical Supervision. The Clinical Supervisor may also make inquiries of relevant individuals, including staff or colleagues;

iii. Review a minimum of ten (10) client charts, to be selected in the Clinical Supervisor’s sole discretion, and review and comment on any issues or concerns arising from this review, including but not limited to Mr. La Rose’s practice management and compliance with mandatory reporting;

iv. Keep a log of all clients whose charts were reviewed, along with client identifier; and

v. Make recommendations to Mr. La Rose for any practice improvements and ongoing professional development, and inquire Mr. La Rose’s compliance with the recommendations.

b. After a minimum of six (6) months of Medium-Level Supervision as described in paragraph 2(b)(xi) of the Order, the level of clinical supervision of Mr. La Rose’s practice may be reduced to Low-Level Supervision for an additional six (6) months, upon my recommendation and as approved by the College in its sole discretion. During Low-Level Supervision, I will:

i. Meet with Mr. La Rose every month;

ii. Review the Log Mr. La Rose is required to maintain and related correspondence, including the requests received, the responses by Mr. La Rose and the associated records and client charts to ensure appropriate documentation. The Clinical Supervisor may conduct an additional review of any records or documents deemed necessary for the purposes of the Clinical Supervision. The Clinical Supervisor may also make inquiries of relevant individuals, including staff or colleagues;

iii. Review a minimum of ten (10) client charts, to be selected in the Clinical Supervisor’s sole discretion, and review and comment on any issues or concerns arising from this review, including but not limited to Mr. La Rose’s practice management and compliance with mandatory reporting;

iv. Keep a log of all clients whose charts were reviewed, along with client identifier; and

v. Make recommendations to Mr. La Rose for any practice improvements and ongoing professional development, and inquire Mr. La Rose’s compliance with the recommendations.

c. Throughout the period of Clinical Supervision, my specific duties will include:

i. Discussing with Mr. La Rose the Log he is required to maintain, the charts I have reviewed, as well as any other concerns;

ii. Making recommendations to Mr. La Rose, including but not limited to recommendations for practice improvements, practice management, and/or continuing education;

iii. Following up on any recommendations that I have made to Mr. La Rose to determine his compliance with the same;

iv. Any other activities, such as reviewing other documents or conducting interviews with staff or colleagues, that I deem necessary to Mr. La Rose’s clinical supervision;

v. Submitting quarterly written reports to the College. Such reports must be in reasonable detail and contain all information I believe might assist the College in evaluating Mr. La Rose’s practice management and compliance with mandatory reporting requirements, including but not limited to a list of all charts reviewed and care observed with patient identifiers, review of charts and care discussed with Mr. La Rose and concerns identified, a summary of the topics that we have reviewed and Mr. La Rose’s success in implementing changes to his practice; and

vi. Notifying the College immediately if I am concerned that Mr. La Rose’s practice may fall below the standard of practice of the profession, and/or that his patients may be exposed to risk of harm or injury.

4. I acknowledge that Mr. La Rose has consented to such sharing of information among myself, any other Clinical Supervisors, Assessors, and the College as any of us deem necessary or desirable in order to fulfill our obligations and in order to monitor his compliance with the Order.

5. I acknowledge that all information that I become aware of in the course of my duties as Mr. La Rose’s Clinical Supervisor is confidential information and that I am prohibited, both during and after the period of Clinical Supervision, from communicating it in any form and by any means except in the limited circumstances set out in sections 36(1)(a) through 36(1)(j) of the Regulated Health Professions Act, 1991, S.O. 1991, c. 18 (the “RHPA”).

6. I undertake to notify the College and Mr. La Rose in advance wherever possible, but in any case immediately following, any communication of information under section 36(1) of the RHPA.

7. I agree to immediately inform the College in writing if Mr. La Rose and I have terminated our Clinical Supervision relationship, or if I otherwise cannot fulfill the provisions of my undertaking.

Signed at

this

day of

, 2025

City/Town

Day

Month

Year

Clinical Supervisor (print name)

Clinical Supervisor (signature)