Chilliwack Waitlist

First name

Last name

How old are you or the individual seeking counselling?

Pronouns

Email

Phone number

Preferred counsellor

Type of service

Individual Counselling

Couple's/Family Counselling

Youth Counselling

Funding sources

Self-Pay (no extended health benefits)

Extended Health Plan

ICBC

CVAP

First Nations Health Authority

WorkBC

Other

Please let us know why you're reaching out

Any additional comments?

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How did you hear about us?

Google/Internet search

Social media (Facebook, Instagram, etc.)

Word of Mouth (Community, Family, Friends)

Psychology Today or other therapist directory

Blog Content

AI Bot Search (Google Overview, Chat GPT, Gemini, etc.)

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