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Forms & Referrals

Welcome to Your Counselling’s Forms & Referrals Centre. This page provides quick access to the forms needed for different services and situations. To make things simple, the table below explains when each form is used. Please choose the one that best matches your needs.

If you’re unsure which form is right for you, our Client Services Team is happy to help. You can reach us at reception@yourcounselling.ca or by phone during regular office hours.

FORM
WHEN TO USE
CLICK TO SUBMIT
Adult Counselling Referral For healthcare providers and community organizations to refer clients to Your Counselling Ltd. Click Here
Group Registration To be added to the registration list for an upcoming group. Click Here
Insurance To set up direct billing. Click Here
Adult Intake To be completed by an individual 18 years and older who is attending a counselling session. Click Here
Adult Guardianship Intake  To be completed by the legal guardian of an individual 18 years and older who is attending a counselling session. Click Here
Child or Youth Intake To be completed by the legal guardian(s) of an individual 17 years and under who is attending a counselling session. Click Here
Group To be completed by the individual attending a group therapy session. Click Here
Outdoor Counselling To be completed in addition to an intake form if the client is attending counselling sessions outdoors. (ie. Walking in park) Click Here
Single Session To be completed by an individual 18 years and older who is attending Single Session counselling. Click Here
Walk in Counselling To be completed by an individual 18 years and older who is attending Walk-In counselling. Click Here
Psychosocial Intake Content 3 2 Click Here
ESS Statement of Understanding  To be completed in addition to an intake form if the client is attending counselling sessions with an ESS Agreement. Click Here
STCF Statement of Understanding  To be completed in addition to an intake form if the client is attending the Start the Conversation Counselling (Sliding Scale Program in Acuity). Click Here
Matching For clients to submit to be matched with a therapist. Click Here
Third Party Payment To be signed by the client (18 years and older) if another party is paying for their sessions. Click Here
Waiver – Midweek Mindfulness To be signed by the client if they are attending Midweek Mindfulness. Click Here
Content 3 2 Click Here
Content 3 2 Click Here