Name *

First Name

Last Name

Phone *

(###)

###

####

My preferred way to be contacted *

In efforts to respect your privacy and meet your needs please let us know which way you would prefer to be contacted by one of our clinicians.

Phone

Email

Type of Counselling Needed *

What type of counselling are you looking for?

Individual Counselling

Couples Counselling

Family Counselling

Child or Teen Counselling

Other

Appointment Time Preference *

Let us know which time of day you would prefer to have your appointments

Daytime Appointments

Afternoon Appointment

Evening Appointment

Anytime

Appointment Type Preference *

What type of appointment are you looking for

In-person

Virtual

Either or works for me

Preferred Clinician *

We offer counselling services by Registered Clinical Counsellors / Psychotherapists as well as Registered Social Workers. Please let us know if you have a preferred clinician. Please note, if you will be submitting your receipts to your benefits provider you might want to check to see what type of clinician your provider covers.

Coleen - Registered Clinical Counsellor & Psychotherapist

Katya - Registered Social Worker

Ava - Registered Clinical Counsellor & Psychotherapist

No preference