African Community Services of Peel- Client Intake Form
Please complete the ACS Client Intake form, detailing the services you are reaching to us about.

For any other questions or concerns, please reach out to us via the contact details below:

Office Number: 905-460-9514
Alternative contacts: 647 570 9514 / 647 451 9514
Full Name *
Pronoun, (Example, she/her or he/him or them/they) *
Email Address *
Phone Number *
How would you prefer to be contacted *
Age Range *
Address/ City/ Province/ Postal Code *
Language(s) Spoken: *
Please choose which Program you require from the list below: *
Please identify which Service you require from the following list: *
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