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Request an Appointment with a Counsellor






*UPDATE as of October 15, 2020* We are still open and are encouraging all clients to try online counselling or telephone counselling from the comfort and safety of their own space. For those that cannot find a safe, private place to meet our therapists will continue to be available like many other workers in the health professions. Mental health is intricately connected to physical health. Because stress suppresses our immune systems, and because people are facing a range of serious challenges we are committed to offering our support. For more information please see our HomePage and Facebook Page.

If you have any issues with our form please call 403.695.7911 and leave a voicemail message and we’ll get you connected with a counsellor as soon as possible. Thank you for trusting us to assist you during this challenging time, we will do our best to respond within 24 hours.

Your Name (required)

Date of Birth (required)

Your Email

Your Phone Number

Can we leave a voicemail message on the number that you have provided?
YesNo

Three main concerns for which you’re seeking therapy or spiritual direction.

I am looking to have therapy covered by benefits.
yesnoIf possible, but not required
*All clients must check with their benefits provider directly on the exact credentials required in order to be covered.

I am hoping to qualify for sliding scale fees?
yesnoIf possible, but not required

Do you prefer a male or female therapist?

Did you have a preferred location?

Preferred mode of Counselling:
In office
Telephone Counselling
Online Counselling

Did you have a particular Therapist in mind?

If that therapist is unavailable, did you have a second choice?

Days/Times Available:
Weekday Daytime
Evening
Saturday
Sunday
All of The Above

Comments on Availability:

Book an Appointment or Start with a 20 Minute Consult:
I would like to start with a free 20 minute consult to get to know my therapist & their approach to treatment

I would like to get started on treatment as soon as possible with a full one hour appointment

Have you worked with one of our therapists before?
Yes
No

If so, please list your previous therapists.

Your quality of service is important to us. Our owner Jennifer Dawn Watts or Director Steven Ngu may follow-up to request for your feedback. Do you consent to receiving contact from either Jennifer or Steven?
YesNo

Anything else you’d like us to know?

Please click Send and wait for the “Your Message Was Sent Successfully” message to show up beside the Send button. This will ensure we receive your form. Thanks!

*Information transmitted via internet may not be secure and by participating, you hereby acknowledge, and understand, and agree to the inherent risks and limitations to confidentiality associated with internet use and telepsychology (e.g., risk of public discovery, internet history discovered by others, possibility of hackers, etc). If you are not comfortable submitting this document online, please print off this page and submit a hard copy to your counsellor during your initial meeting.*