CLIENT INTAKE FORM

 

Please complete the secure form below if you are interested in starting your counselling journey. The information you provide will help us connect you with the best counsellor to meet your needs.

    ARE YOU A RESIDENT OF BRITISH COLUMBIA?

    ARE YOU A REGISTERED WITH FIRST NATIONS HEALTH AUTHORITY?

    IF APPLICABLE, INDICATE IF YOU ARE A:
    Former Indian Residential School studentFamily Member of a former Indian Residential School studentFormer Indian Day School studentFamily member of a former Indian Day School student

    DO YOU PREFER TELEPHONE OR ONLINE VIDEO COUNSELLING?
    TelephoneOnline Video

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