Counselling Appointment Request Form

Start the conversation

By filling out the Counselling Appointment Request Form below, you are taking the first step towards the change you want to see in your life. There is no obligation to start counselling once you’ve submitted this form. We will have the chance to talk before setting up your first appointment. Once your form is received, we will contact you within 48 hours to discuss your counselling needs further. You may also choose to contact us by telephone at 613-769-4181.


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