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Name
First
Last
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Pronouns
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he/him
she/her
they/them
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(Required)
-None-
Younger then 10
10-13
14-17
18-25
26-39
40-59
60+
Phone
(Required)
Email
(Required)
Services Interested In:
(Required)
Psychotherapy
Physiotherapy
Osteopathy
Massage Therapy
What are you looking for help with?
(Required)
Which practitioner would you like to work with?
-None-
Aaron Halliday
Jamie Couling
Laylin Keyes
Robert Simms
Sonia McDiarmid
What type of appointments would you prefer?
(Required)
-None-
In-person
Online
I have no preference
Client Availability
(Required)
-None-
Daytime
Evenings
Weekends
If you are looking for counselling, please let us know who it is for
-None-
Individual
Couple
Family
How will you be paying for your appointments?
(Required)
-None-
I am paying for these services on my own
I am using my extended benefits
ICBC
Crime Victim Services
Metis Nations BC
Autism Funding
FNHA
Reduced Rate Services
-None-
I am able to access full-rate services
I am in need of reduced rate services and open to working with a Masters-level student.
How did you hear about us?
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-None-
Google Search
Instagram
Facebook
A family member or friend
Facebook group referral
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