Welcome to the Online Intake System

Please fill in all the fields and press the save or continue button at the bottom of each page in the process. This will take about 30 min of your time. Your Personal Information will be kept secure and will not be used outside of Calgary Counselling Centre. If you would rather fill out the form manually, you can download an Intake Form and fax it to (403) 265-8886.You may also phone Intake at (403) 691-5991 to register for counselling. Upon receipt of your form, a counsellor will contact with you within three to four business days.

Please answer all the questions in this section as your answers will determine which forms you will complete

Do you have a live-in Partner?	Yes	No
Do you have other live-in family members?	Yes	No
Do you or your Partner have Insurance to cover counselling?	Yes	No
Have you had counselling at Calgary Counselling Centre BEFORE the year 2000?	Yes	No
Have you had counselling at Calgary Counselling Centre AFTER the year 2000?	Yes	No
Have you received counselling from another agency?	Yes	No

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