Let’s Get Started! Fill out the form below and we will connect with you to discuss the next steps in getting you support. "*" indicates required fields Name* First Last Email* Phone*May we leave a voicemail at this number?* Yes No I would like to be contacted by:*(check all that apply) Phone Call Text Email (please check your junk folder) I have insurance and my provider is:* Green Shield (SFC can bill directly) Another provider (you will pay SFC out of pocket and submit your receipt) I have insurance coverage for:*(check all that apply) Registered Psychotherapist (RP) Registered Social Worker (RSW, MSW/RSW) Certified Canadian Counsellor I will check and let you know I do not have insurance coverage and will pay out of pocket Availability for Appointments*(check all that apply) Monday 1:00 – 7:00pm Tuesday 1:00 – 7:00pm Wednesday 1:00 – 7:00pm Thursday 1:00 – 7:00pm Friday 1:00 – 7:00pm Saturday 9:00 to 3:00pm Sunday 9:00am to 3:00pm Mornings available upon request Please select who the counselling services are for:* Child under age 6 (which is parent focused) Child between 7 to 10 years Tween between 11 to 13 years Teenager between 14 to 17 years Young adult between 18 to 25 years Expecting or New Parents Parent(s) only Other Please specify*Please describe the primary concerns that have led you to seek counselling services?*What changes would you like to see as a result of coming to counselling?*Is there any other information you would like us to know?*Is there a Family Counsellor with whom who prefer to work with?* We ensure to match you with a Family Counsellor that is best suited for your needs, however we will take your preference into consideration. How did you hear about our services?*CAPTCHA
