Getting Started

To get started we ask that you fill out the following form and answer the questions to the best of your ability. This form will allow us to understand your situation and find a counsellor that suits you.

Who are you reaching out for? *MyselfMy Partner and IMy DependantMy Family

On a scale from 1-10, how would you rate your overall stress level?

What are the major causes or factors of your stress? Check all that apply:FinancialFamilySpiritualCareerRelationshipPre/Post Natal ChangesHealthPersonalOther

Do you actively participate in any spiritual practices?YesNo

What is your current relationship status?

How would you rate the health of your relationship? Please rate on a scale from 1-10 (1 being low and 10 being extremely high)

Comments

What led you to seek support at this time?

How long have you been having these challenges?

Have you received support in the past? If yes, please check all boxes that apply:CounsellingMedicalPeerFamilyOther

What are you hoping to gain from counselling?