Connection Form
Please fill out the following form and you'll receive an email response with the name and address of the person who will be reaching out directly to you!
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Age Category
*
8-12
13-18
18+ (Adult)
What Services Are You Seeking
*
Counselling (Mental Health & Trauma)
Energy Healing
Connection Option Preference:
*
Virtual Counselling
In-Person Counselling
Combination of Both
No Preference
What Days of the Week Work Best for You?
What Time of Day Works Best for Your Schedule? (Morning, Afternoon, Evening)
Is there someone you specifically would like to connect with?
No Preference
Lea Morrison (Energy Healing)
Michelle Tucsok (Social Worker)
Haida Gaide (Clinical Counsellor & Social Worker)
Kyle Loney (Clinical Counsellor)
Samantha Hellwig (Clinical Counsellor)
Lauren Nutbrown (Clinical Counsellor)
Paige Mathison (Clinical Counsellor)
Please provide a brief description of what you'd like support with and any questions you may have!
*
Submit
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