Calgary Counselling Centre - Intake Form

Welcome to our Online Intake System

Please fill in all the fields that apply to you. This will take about 10-15 minutes 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 email it to or fax it to (403) 265-8886. You may also call our office at (833) 827-4229 to complete an intake by phone. If you have any questions or concerns, please contact the intake department at (833) 827-4229.

For the most part, we are able to match you with a counsellor within two business days. But, at this time of year, we have counsellor transitions with new counsellors beginning in May. Therefore, there may be a small wait in our being able to match you to your counsellor. We appreciate your patience. If you need to talk with someone before you hear from your counsellor, contact us at 833.827.4229. Effective March 1, 2022, counselling sessions continue to be provided online and over the phone.

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

Are you married, or have a partner you live with?
Do you have other live-in family members (including children)?
Do you or your partner have insurance to cover counselling?
Have you received counselling in the past?