Contact Form For New Clients

Your Details

First Name *

Last Name *

Email *

Phone *

Preferred Contact Method

Type of Service

Preferred Counselling Format

Counsellor Preference

Will the client be located in BC for the duration of counselling?Most of our therapists are able to work only with residents of British Columbia, though temporary travel outside of BC during counselling may still be possible.YesNo

Which province/country will you be in?

Are you 19 years or older?YesNo

Do you have extended coverage or a third-party funding source?We can provide receipts for reimbursement through your insurance or coverage plan, and in some cases may invoice third-party funders directly. We will confirm billing arrangements with you prior to your first session.Autism Funding BC (AFU)Crime Victim Assistance Program BC (CVAP)First Nations Health Authority (FNHA)Insurance Corporation of British Columbia (ICBC)Other

Who were you referred by? Please type name below.

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Please include only basic contact details and a brief message about your inquiry. For your privacy and security, we ask that you avoid sharing detailed personal or health information through this form.

If your matter is sensitive, please contact us by email or phone instead.