Focused Counselling Intake Form Logo
  • Focused Counselling Intake:

  • Please ensure that your contact information is entered correctly (ie: email address) as we cannot be held liable if your information goes to an outside party due to an error made while entering such information on the intake form. 

    Thank you.

     Please Note: If multiple people would like individual therapy please fill out seperate intake forms. 

    • How many people will be attending therapy? 
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    • Thank you!

      Once we receive your intake form, you will receive contact from our Intake Department within 10 business days via Email. Please ensure you check your Junk Mail folder in case our email gets redirected there.
    • Should be Empty: