Counselling Inquiry Form for New Clients in Langley, BC Get Started Today! Name * First Name Last Name Preferred Contact Method * Phone Email Phone * (###) ### #### Email * Do you have extended health insurance? * What days of the week work best for you? * Monday Tuesday Wednesday Thursday Friday Saturday What time of the day works best for you? * In person, online/virtual, or telephone call * In person Virtual Phone Counsellor Natasha Cherise No Preference What type of counselling services are you seeking? * Individual Counselling Couples/Relationship Counselling Divorce and Separation Family Counselling Youth (16+) Counselling Reasons for seeking counselling? * How did you hear about us? * Social Media Google/Search Engine Referral - Friend/Family Referral by Doctor/Therapist Referral by Community Organization Other Thank you for reaching out! We’ve received your inquiry and will get back to you within 24-48 hours to discuss your counselling needs. Your well-being is important to us, and we’re here to support you every step of the way. In the meantime, if you have any urgent concerns, feel free to contact us directly at 778-835-3107.We look forward to connecting with you soon.
