Intake Page Let us help you find the right therapistThe right counsellor We’ll match you with a counsellor best suited for your unique challenges, goals, and circumstances. If at any point in this process you’d like to talk directly to one of our staff instead, please contact usWhat type of counselling are you interested in? Individual Counselling Relationship CounsellingWhat is your name? Name Where are you located? Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan YukonPlease note: We’re not currently accepting new clients in Ontario, but please proceed with this form if you wish to be placed on our waitlist.What are some of the specific areas you'd like support with? We include examples to give you an idea of some typical answers, but please don’t let them limit you.(Examples may include anxiety, depression, life transitions, stress, body image, self-esteem etc).What are some of the goals you’re hoping to work towards through counselling?(Examples may include validation, perspective, feedback, solutions, goal setting, caring etc).What kind of people do you find yourself naturally gravitating towards in your personal life?(Examples may include extroverts, introverts, caring, funny, hopeful, realistic, pragmatic etc).Do you have a preference for a counsellor with the following lived experience?We can’t guarantee that a counsellor with that lived experience will be taking new clients, but will offer you the best fit based on current availability Black Indigenous Person of Colour LGBT2SQIA OtherOtherWhen are you typically the most available?(We have the most availability Daytime Monday to Friday in case you’re trying to get in sooner) Daytime Monday to Friday Evenings Monday to Friday SaturdaysWhat’s your preferred counselling format? In Person (with pandemic-appropriate safety/cleaning precautions) Online (Virtual Counselling) A mix of bothHow did you find out about Peak Resilience?Online ad? Friend referral? Professional referral? We love to know how our message is reaching people!Are you interested in working with a Practicum Student?(depending on eligibility and availability) Practicum student sessions are a lower cost option. Yes NoWe reserve a small portion of our sessions at a lower rate for people who do not have Extended Health Benefits or people experiencing financial hardship. So tell us, would you like to learn more about the sliding scale rate? Yes, I am interested in learning about the Sliding Scale rate.Do you have access to any of these supplemental funding sources? Crime Victim Assistance Program ICBC Counselling Funding Extended Health Benefits OtherOther funding source descriptionThis form will send us an email and we will get in touch by email or phone, depending on what information you provide below.Enter your email*We ony use this information to respond to your questions. Enter your phone number*We only use this information to respond to your questions
