Online Application Complete our online form below to be matched with a counsellor. Please select from one of the following services. * Extended Health Care Benefits or Private Pay Pro Bono Counselling with Student Counsellor Personal Information First Name Last Name Email Telephone Date of Birth Mailing Address Are You a Resident of British Columbia? Yes No Which of The Following Services is Your Preference? Telephone Online video Either Counsellor Preference Any Anastasia Truman David Minor Reasons for Seeking Counselling What is Your Availability for Appointments? Emergency Contact Full Name Telephone Number I agree that the information I’ve provided is correct and understand that my details will be kept confidential. I give my consent to receive counselling services. Submit
