Therapeutic Service Intake Form

If you are having a mental health emergency, please contact the 24 Hour Mental Health Crisis Line at (441) 239-1111.

Before completing this form, please review our WRC Service Policy.

To access any of the following services, this intake form must be completed:

  • Individual Counselling

  • Restorative Mediation

  • Co-parenting Mediation

Fee: $100 per session

Need support? Sponsorship is available for those facing financial hardship.

Please complete the Sponsored Services Application to apply.

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WRC Service Policy

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Sponsored Service Application Form