Intake form

Please complete our intake form if you are interested in counselling.

Please Read: 

During the free intake session, you will be asked about your counselling needs. We will discuss NFLA policies, your counselling options, and sliding-scale payment plans. We aim to assign a counsellor within 48 hours. Our services include individual, youth (1318), and couples counselling.

Intake Form

Please be advised that the Personal Information Privacy Act protects any information gathered. 

Name
Pronouns
Address
Is it okay to leave a message?
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When are you available for counselling? Please check the days and identify the times between 8:30a.m and 8:00p.m 
Would you like your free intake session to be by phone or online? 
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