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Counselling Intake

Interested in booking a counselling session? Please fill out the Intake Form below, and we will email you with a few suggested appointment times based on your stated availability. We use email for all communication unless you request a callback.

Intake Form

Date of Birth

Gender

I am seeking help for (select all that apply)

Situational / life issues

Depressed mood

Anxiety

Anger

Relationship difficulties

Low self-esteem

Thoughts of suicide

Willing to discuss in session only

Other issues or background (if applicable)

I am seeking:

Home visit counselling

Virtual counselling

Couples counselling

I am available / prefer sessions on:

Weekday mornings

Weekday afternoons

Weekday evenings

Weekends (mornings only)

Availability notes

I agree to the Terms of Use and Privacy Policywhich can both be viewed here

Thank you. Your Intake Form has been received.

By using this website, including submitting information via web forms, you ageee to our Terms of Use and Privacy Policy

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