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Fill out the following form and we will get in touch with you to make your first appointment.
If you already have a counsellor you can book an appointment.

What is your name?

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Would you prefer a male or female counsellor?

Do you have insurance coverage through your employer?

Who is your benefit provider?

What is the reason for your request?

Have you discussed counselling with your child / teen prior to making an appointment?

How would you like to be contacted?