TP Clark by Solace Wellness

Name (Optional)

First NameLast Name
Personal Phone Number*
Please enter a valid phone number for our counsellors to reach you.
Active Personal Email*
Please provide a valid email address for RCs to send the session schedule and call link.
WebEx Handle (Optional)
Please create your personal WebEx account using your personal device, if you prefer to chat with the RC.
I intend to book this session for*

myselfmy colleaguemy direct report
Line Of Business (LOB)*
Work Setup*
Choose Your Preferred Counselor*
Preferred Shift*
Rest Days*

SaturdaySundayMondayTuesdayWednesdayThursdayFriday
Employment Status*
How would you prefer we reach out to you?*
Referee's Phone Number*
Please enter a valid phone number for our counsellors to reach you.
Referee's Active Personal Email*
Please provide a valid email address.
Referee's Employment Status

ActiveNot Active
Please Choose Your Preferred Date And Time (1 hour slot)*
Choose Your Preferred Coach (Comm-WFH)*
Choose Your Preferred Coach (BI-WFO)*
Choose Your Preferred Coach (BI-WFH)*
Choose Your Preferred Coach (Comm-WFO)*
Employee ID No. *
Message (please state your concerns as best as you can)*
Information provided is strictly confidential.
Should be Empty: