Mental Health and Wellness Consultation Booking and Financial Assistance Form
The Newmarket African Caribbean Canadian Association (NACCA) has a mandate to connect and build community, support and strengthen Black families and businesses and empower Black youth. With the generous funding support of The Canadian Red Cross, NACCA is pleased to be able to offer a range of culturally relevant mental health and wellness supports to members of the Black community in York Region. Visit www.naccacommunity.ca to learn more about us.

Completion of this form provides NACCA with the information needed to connect you to services that will best support your needs. All responses are bound by NACCA's confidentiality policy. Identifying information will only be shared with therapists you wish to work with. Demographic information (ie. age, race) will be used for reporting purposes only.

If you are experiencing financial hardships, subsidies are available for individual and family counselling. Please speak directly with your therapist for more information.

Please respond to all questions providing as much detail as you feel comfortable sharing.
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