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Accelerated
Intake Form

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What type of counselling are you interested in?IndividualCoupleFamilyPremarital

Preferred type of counselling sessions

• In-person
• Online
• Phone

Availability

• Mornings
• Afternoons
• Evenings
• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday

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How did you hear about the Community Counselling Centre?

• Previous client
• Friend, Family, Colleague
• Google
• Other internet search
• 211, 811, or 24/7 Access
• University/School
• Social Media
• Doctor, Counsellor, Social Worker
• Insurance
• Other

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