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In crisis? Contact CRCL North Shore. Call: 1 (888) 261-7228 or Text: (778) 839-1831

Request
Counselling

We can help if you’re going through a difficult time or life transition, need help with an important decision or relationship challenge, or if you need tools to cope with stress, anxiety, depression, or anger.

Fill out the counselling referral form below to request counselling.

Counselling Referral Form

First name(Required)
Last name(Required)
MM slash DD slash YYYY
Your City and Postal Code(Required)
Select your counselling tier(Required)
Select your preferred counselling method(s)(Required)
Which days are you available for counselling sessions? (Select all that apply) Note: sessions are booked between 9:00 AM and 4:00 PM(Required)
Select your preferred language of service (French and Farsi services provided by RCCs only)(Required)
Permission(Required)
This field is for validation purposes and should be left unchanged.