Request for Service -
Online Intake Form
Fill out this form to access individual/family counselling. Feel free to call us at 519.884.0000 x222 with any questions.
Our counselling services are only available in Waterloo Region, Ontario, Canada.
Please be advised that it can take 2-4 business days for an intake worker to contact you. If you are in immediate crisis please call 519 745-1166 or visit the crisis clinic at Grand River Hospital.
If you have questions please contact our Intake team at 519.884.0000 x222 or email@example.com.