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Intake Forms

Please download the following documents (3 docs) and them by email to or send them by confidential fax to 519-204-3886. Then book a session time under the Book a Session tab. This confidentiality of this information is protected by a highly secure filing system.

Intake form (referral)
Consent to treatment
Consent to release information
Print Brochure

First Nations Counselling Portal Ontario & British Columbia
...Promoting culturally-immersed support and access to Psychotherapy and Counselling Services across Ontario and British Columbia


Trauma-Responsive Counselling Support for Mental Health Crisis and Residential School Health Supports, Indian Day School, MMIWG for First Nations in Ontario and British Columbia.

Online by Appointment Only

*No referral required

Located in London, Ontario


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