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 (13−18), 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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