New Client Pre-screening

Thanks for your interest in receiving counselling with our Community Counselling Program.

This free program is being offered by CCS without a funding source. Availability of counsellors is limited to the student counsellors we have available and the guidelines of their placement with us. See profiles of our current counsellors here.

If you would prefer to complete this form in-person or over the phone, contact our reception at 250.426.2976.

Community Counselling Pre-screening

Name *

First

Last

Email *

Phone Number *

Why are you seeking counselling? *

Are you waitlisted for services elsewhere? *

• Yes
• No

If they've given you an approximate wait time for services, enter that time frame here.

Your Age *

• 10 to 17
• 18+

We are only able to accept clients ages 10 and up.

Parent Name and Phone Number (if client is under 18)

given they've Number

Counsellor Preference *

• Nancy Reid, MSW
• Suzanne Thompson, MCAP
• Kyla Hambly
• No preference

Due to factors including practicum guidelines and scheduling, we may not be able to match you with your preferred counsellor.

Do you prefer in-person or virtual appointments? *

• In-person
• Virtual
• Both

When are you usually available for appointments?

• Monday morning
• Monday afternoon
• Tuesday morning
• Tuesday afternoon
• Wednesday morning
• Wednesday afternoon
• Wednesday evening
• Thursday morning
• Thursday afternoon
• Friday morning
• Friday afternoon
• Saturday morning

We will use your availability to help match you with your counsellor, as appointment times vary by counsellor.

Submit