Thank you for filling out this application for counselling form as best as able prior to the initial intake/counsultation session. If you haven't aquainted yourself with the services and my qualifications, you may want to visit https://morellifamilycounselling.ca. I am a qualified Registered Clinical Counsellors (RCC) and have ongoing supervision from Michael Cameron (RCC) and had extensive training with Dr. Madeleine De Little. You can also find out more about my approach from counselling on her webpage https://wherewordscannotreach.ca.

Please note that at current, there is not an anticipated waitlist; therefore, I am  currently placing families who fill out this application, on a first-come, first-served basis. Once this form is submitted you will be contacted generally within 1-2 days.  Also, counselling sessions and availability are possible on Saturdays 9:00 am - 2:30 pm and anticipated to open up to Mondays 3:30 pm - 8:30 pm in the near future.

If you do not hear from us within 2 days of submitting this form please contact me at dgmorelli70@gmail.com. In the meantime, if you find another therapist please let me know.

We invite adults who wish to pursue a playful, creative way of doing therapy using a sand tray and figurines. In particular, this method through the use of Neuroscience and Satir in the Sand Tray, if an effective way to help adults who have had early past traumas such as serious neglect, sexual abuse, ritual abuse, and abduction that continue to impact their lives and relationships today.

I acknowledge that all information provided will be treated as confidential by the practice and the counsellor except for the following reason, in which case the counsellor is required to inform the appropriate people:

• The counsellor believes that a child or vulnerable person is at risk of harm,
• The counsellor believes that you are at risk of harming yourself or another person; or,
• It is required by a court order

Please Note regarding Insurance Coverage:

As I am a Registered Counsellors and should be covered under your extended medical. However please check before beginning counselling to see if you do have coverage. This also applies to whether you are applying for counselling through Family and Employee Assistance Programs.  Do check to see if you are planning to use FSEAP/EAP benefits if the services provided here are covered.

Agreement:

My signature below confirms that I have completed this application to the best of my ability and have fully read all statements listed above.

I acknowledge that this application does not guarantee being seen by the counsellor (Duane Morelli), and will be responded to in the order in which it has been received.

I agree to having photographs of my work used for teaching purposes and consultation with a clinical supervisor by Duane Morelli.