Confidential Consult Intake Form

(Two Minutes to Complete)

Dipping your toes into counselling - even in a small way - can feel unsettling.

That's normal. So - we want to support you in feeling as calm and grounded and relaxed as possible. That way, in the session ahead, you can explore and learn a bit and maybe get some sense of how counselling might help you out.

Filling out this Confidential Form gives us a little info about your preferences. Hopefully we can use it to set up a space for you where you feel at maximum ease...

What kind of support are you most drawn to right now?

Approaches to Support:

A steady, attentive presence where I can speak freely and be met without direction or instruction. I tend to do my best work when there’s space to hear myself think and feel.

A balance of open listening and occasional guidance or reflection from the counsellor. I value space, but also appreciate gentle input when it feels helpful.

More active guidance, structure, or feedback from the counsellor. I’m looking for someone to help me make sense of things and offer direction.

I'd like support in being present with what's most uncomfortable. I'm most interested in the freedom that comes through deepening the ability to be with what is.

Are there any spiritual, philosophical, or cultural traditions that meaningfully inform how you see the world or how you try to live?

Which traditions - if any - influence how your sense of meaning and sacredness?

Eastern traditions (e.g. Buddhist, Daoist, Zen, Confucian, Tibetan)

Indigenous or land-based approaches (e.g. ceremony, ancestral traditions, plant-spirit medicine, earth-centered practices)

Yoga or contemplative traditions (e.g. yoga philosophy, meditation lineages, embodied spiritual practice)

Christian or Biblical perspectives (including contemplative or mystical strands)

Western philosophical or existential traditions (e.g. depth psychology, existential philosophy, humanistic approaches)

A personal or eclectic path (drawing from multiple sources or lived experience rather than a single tradition)

Other

How does trauma currently show up in your life, if at all?

Your Relationship to Trauma:

Trauma plays a significant role in my day-to-day life. I may be living with ongoing PTSD symptoms or impacts that affect my relationships, work, nervous system, or sense of safety.

I feel mostly stable in my life now, but I’m interested in reflecting on past experiences as part of growth or integration. I don’t feel overwhelmed by trauma day to day, but I sense there’s value in gentle exploration.

I don’t feel that trauma is a central concern for me. My reasons for seeking counselling are more about meaning, direction, relationships, or other areas of life.

I notice patterns, sensitivities, or “quirks” in my daily life that might be connected to past experiences. I’m not certain how trauma fits, but I’m open to exploring whether there’s a connection.

How central are romantic or intimate relationships to what you’re hoping to explore right now?

Exploring Relationships:

I’m mainly interested in individual reflection. I want to understand myself more clearly, including how I show up in relationships, but I’m not looking to work with a partner in sessions.

Relationships are an important area of focus for me. I’m interested in exploring patterns, communication, or dynamics in my relationships, and I’m open to relational or partner-involved work.

My interest is specifically around intimacy, sexuality, or conscious relationship. I’m drawn to exploring these areas in a more focused or intentional way, possibly with a practitioner who specializes in this territory.

Romantic or intimate relationships aren’t a primary focus for me right now. My interests lie elsewhere.

Is there anything else you'd like us to know?

Additional Info

One last time, please submit your contact information.

(This ensures we keep good track of you in our files and communications...)

Your Name

First Name *

Last Name *

Your Best Email Address

Email *

Your Phone Number

Phone *