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Section 1 of 2
Counselling for All: Intake Form
Please fill out this form to request counseling services with Counselling For All. Completing this form will take approximately 5 to 10 minutes and is essential for gathering the background information necessary to match you with an appropriate therapist. 

We are committed to supporting individuals from all faiths, ethnicities, sexual orientations, gender identities, and financial backgrounds. Financial constraints should not hinder your access to mental health care. Due to the high demand for mental health services, our resources are limited. Based on the information you provide and your counseling intake questionnaire, your therapist will discuss the number of approved sessions and the associated fees.  Subsidized rates are available based on approval from our financial assistance committee. 

Rest assured that all information collected through this form will be treated with strict confidentiality in accordance with the Personal Information Protection and Electronic Documents Act guidelines. We do not share your information with any third parties; the details you provide will solely be used to facilitate affordable counseling assistance. 

If you have any questions or concerns regarding the information being collected, please do not hesitate to contact our office at +1 (855)-453-5530 or via email at Admin@CounsellingForAll.org before completing the form.

We acknowledge that our head office is located in the unceded territory of the Coast Salish Peoples, including the territories of the xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish), and səlilwətaɬ (Tsleil-Waututh) and that our staff live and work in unceded territories across Canada. We acknowledge territory and First Peoples, and we commit to genuine and ongoing work to forge real understanding and to challenge the legacies of colonialism.


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Section 2 of 2
Background Information
This section of the form aims to gather background information regarding your current circumstances, enabling us to better comprehend your needs and tailor our support accordingly.
Please briefly describe your previous experience, if any, with counselling.
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How would you describe your current life situation?
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I'm a student
I'm a veteran
I'm an individual with a disability
I'm unemployed
I'm employed but my income is low
I'm employed but I have increased financial obligations
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Do you require access to affordable counselling. Please explain.
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Please share with us what your short term and long term goals are for your mental heath jouney.

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How did you find out about Counselling For All services?
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What rate would you feel comfortable paying for a 50 minute counselling session? Please pick the one that feels most feasible for you at this time. 
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$0 to $50 (Associate Therapist only)
$60 to $80 (Fully Licensed psychotherapist with less than 5 years work experience)
$90 to $110 (Fully Licensed psychotherapist with 5 to 8 years work experience)
$120 to $140 (Fully Licensed psychotherapist with 9 to 10 years work experience)
$150 to $170 (Fully Licensed psychotherapist with 10 years or more experience with specialized trainings and expertise)
$180 (Fully Licensed psychotherapist with 10 years or more experience and specialized trauma certification)
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Thank you for completing the application. 
Please note that our office will contact you within 2 business days. You can also book an intake appointment using the link below or also call/ email the office at +1 (855)-453-5530 / admin@counsellingforall.org
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