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 intake@kwcounselling.com.

 9am-12pm 12pm-3pm 3pm-6pm 6pm-8pm

 Yes Yes, but be discrete No

 Telephone Email

 Individual Counselling Family Counselling

 Yes No

 Yes No

 Yes No

 Yes No

 Yes No

 9am-12pm 12pm-3pm 3pm-6pm 6pm-8pm

 Counsellor/Therapist Family and Children's Services Family Doctor Friend GSA (Gay Straight Alliance) OK2BME website OK2BME staff OK2BME sticker, brochure, poster Parent Parole Officer Public Health Nurse School Guidance Counsellor Sibling Teacher Other