Accelerated Intake Questions

Please complete the form below or give us a call at (780) 482-3711.
Our Intake Team will get back to you within 1 business day.❤️

(The information you provide is strictly confidential and protected by an SSL Security Certificate.)

Please enable JavaScript in your browser to complete this form.

Accelerated
Intake Form

Name *

First

Last

Email *

Phone

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

Comments

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

Submit