CLIENT INTAKE FORM

NOW ACCEPTING NEW CLIENTS!

Please complete the intake form below if you would like to work with one of our counsellors. Current wait time is between one and three months, depending on the availability of both parties. This is an estimate and you may be connected with someone sooner if a space with a counsellor becomes available.

    PRE-INTAKE
    Please acknowledge that you have reviewed and understand the following information before completing the online intake form:

    Appointment Cancellation & Rescheduling Policy

    I understand that a Credit Card, Visa Debit Card, or Debit Master Card is required to secure an appointment in accordance with the clinic's Appointment Cancellation & Rescheduling Policy.

    Crisis Counselling Policy

    I understand that Metro Vancouver Indigenous Counselling is not an emergency service and may not be suitable for individuals seeking immediate assistance.

    PERSONAL INFORMATION

    ARE YOU A RESIDENT OF BRITISH COLUMBIA?

    ARE YOU REGISTERED WITH FIRST NATIONS HEALTH AUTHORITY?

    WHICH OF THE FOLLOWING SERVICES IS YOUR PREFERENCE? (SELECT ONE):
    Please note: In person counselling is currently only available in Vancouver on a limited basis.
    Telephone CounsellingOnline Video CounsellingIn-person Counselling

    IF THE COUNSELLING PREFERENCE YOU SELECTED ABOVE IS NOT AVAILABLE, WOULD YOU BE OPEN TO ANOTHER OPTION? (PLEASE NOTE: THERE IS A LONGER WAIT TIME FOR IN PERSON COUNSELLING SERVICES)

    ARE YOU OPEN TO SEEING AN ALLY COUNSELLOR IF AN INDIGENOUS COUNSELLOR IS NOT AVAILABLE?
    YesNo