Are you seeking counselling for yourself or someone else?
Reason for seeking services
Have you (or the person you’re filling this out for) had counselling in the past?
If yes, specify the outcome and if it was positive or negative:
Location (City/Town for timezone calculation)
Where did you hear about us?
Are we permitted to send you text messages?
Are we permitted to leave voicemail messages?
Do you know anyone who is a current, or was a past, client of ours?
Please share their name and if you know who they are working/worked with.
*Please note this information helps us to prevent any conflict of interest when assigning clients to one of our counsellors.
What approach do you prefer from your counsellor?
Counsellor Gender Preference
Are there any barriers/reasons why you would not be able to attend sessions online?
If yes, please let us know the reason below
Preferred day(s) and time(s) of appointment.
Please note that we cannot guarantee accommodation of this preference, but we will do our best!
