Intake Form

IF YOUR INQUIRY IS AN EMERGENCY, PLEASE CALL 911, YOUR FAMILY DOCTOR OR THE CRISIS LINE AT 1-800-353-2273. 

We provide free and confidential counselling to individuals or groups dealing with their own or someone else's addiction or substance misuse.

To assist with your first or intake appointment with a counsellor, we require all new and returning clients (after three months) to complete an intake form. Once you press the "Submit" button on the last page of this on-line intake form, a staff member from the office closest to you will make contact within three business days to book a counselling appointment. Please contact our office should have questions. Refer to our contact us page for the location closest to you. 

If you prefer an alternate version of our intake sheet, you can find them here: 

Ekass Intake Aug 2019 Ekass Intake Aug 2019 (127 KB)

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