Contact Information for Client 1 (Main Contact) Is it ok to leave a message at this number?
Personal Information, Client 2 (Partner)
General Information What format of counselling would you prefer (check all that apply)
Choose the days and times that you are available for counselling. Please choose carefully as these times/days will be used to set up your future appointments. Please note, counsellor availability is limited on Saturdays and Sundays.
Presenting concerns, click all that apply:
Financial and Payment Information
Please note, as of March 1, 2022 our counselling rate is $130 per session to see one of our Clinical Counsellors.credit card, visa/MC debit, either before or during your first appointment. All payments will then be processed at the end of each counselling session by your counsellor. We do not accept e-transfers. For in-person sessions we accept credit card, debit card or cheque.
Counsellors
Other Have you had any previous counselling at our Centre? If available, would you like to see this counsellor again? How did you find out about us
Our Disclaimer:
South Island Counselling is a non-profit organization attempting to alleviate the immense need for affordable mental health services. We will not tolerate any harassment, hostility, or any form of aggression or abuse towards any of the counsellors or staff at any time. If we feel a client or potential client has committed any of the above, we will not provide counselling services. Submit form
