LGBTQ2+ Request for Counselling

Fill out this form if you are an LGBTQ2+ youth in need of counselling services. Feel free to call us at 519.884.0000 x222 with any questions.

Services available to residents of Waterloo Region, Canada only.

If you are in immediate crisis please call Here 24/7 at 1.844.437.3247 or visit the crisis clinic at Grand River Hospital.

Note: This form is transmitted via e-mail and may not be secure.

Only fill out this form if you are the person who will be receiving counselling.

YesNo

TelephoneEmail

YesNo

YesNo

If you are in immediate crisis please call Here 24/7 at 1.844.437.3247 or visit the crisis clinic at Grand River Hospital.

YesNo

9am-12pm12pm-3pm3pm-6pm6pm-8pm

We will respond to your request via email.

Check out other resources here.