Please fill out all mandatory fields in order for us to know how to best serve you. Once you have submitted this form, you will be added to the appropriate waitlist. You will be contacted when a counsellor has a spot available for you. Once this form has been submitted, the Intake Worker will print off a copy for our records and delete the online version. This record will only be accessible to the Counselling team.
If you need to later update your information or need technical support in completing this form, please contact our Intake Worker directly at 519-571-0121 x 804 or at firstname.lastname@example.org