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 to two weeks, depending on the availability of both parties.

If you are unable to complete this form online or require additional assistance, please give us a call at (604)256-5850 and leave a message with your name and telephone number and someone will get back to you as soon as possible.

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

    1. 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.

    2. There are four groups that are not covered by the First Nations Health Authority because they are in a self-government agreement and have assumed the administration of their own benefits. This includes the following groups:

    i) Nisga’a Nation, including: Gingolx #671 (Kincolith), Gitakdamix #677 (New Aiyanish), Lakalzap #678 (Greenville), & Gitwinksilkw #679 (Canyon City)

    ii) Inuit

    iii) Mohawks of Akwesasne #159

    iv) Bigstone Cree #458

    I confirm that I am not a member of one of the groups listed above.

    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 ALL THAT APPLY):
    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