Intake Form
The purpose of this questionnaire is to obtain an idea of the problems or issues that you want to speak with a counsellor about and your expectations in order to facilitate the counselling process. By completing the following information, more efficient and effective use of your counselling sessions can result.
You may be concerned about what happens to this information because it is highly personal. No one outside of this counselling centre is permitted to see your case records without your permission.
You may complete the form below or we can e-mail or fax the forms to you. When you come to your first session, you should give this form directly to your counsellor.
*Please print and complete the PDF form or submit the online form below. Please phone or e-mail our office if you have not been contacted within a week after your form submission.