I would like to connect on:(Required) Mindfulness-Based Creativity Group (Beginning early 2026)) Family Counselling Family Support Youth Support Youth Counselling High School Youth Counselling & Support Drop In Adult Addictions Services Youth Addiction Services Stopping the Violence for Women Gender-based Violence Infant Development Name(Required) First Last Phone(Required)Email(Required) Date of Birth:(Required) MM slash DD slash YYYY Gender(Required)Address(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Are you parenting children/youth under the age of 19?(Required)YesNoIs it ok for us to leave you a voicemail (for privacy reasons)?(Required) Yes, you may leave a voicemail No Do you have work related benefits? Yes No We do not accept workplace benefits. We encourage to access alternative services through your workplace benefits.How did you hear about us? Friends/family Self Other Tell us more about how we can help(Required) If this form does not load, please refresh the page
