Couples Form

If you are in crisis, please call the crisis line at: 705-495-8198 or 1-800-352-1141.

This form is for couples seeking VIRTUAL Walk-in counselling. Please note, each partner must submit a separate form.

Our same day call-in clinic is for a single telephone session appointment today. Make sure you are in a comfortable and private area for your appointment. If you are not ready or able to speak to someone today, please register on a day you are available.

You also have the option of coming IN PERSON for a face to face session on Tuesdays and Thursdays between 1 and 7 pm. If you come in person – registration here is not required.

We will explore different ideas to help you with whatever is on your mind. Our approach focuses on solutions and the strengths you and/or your family possess. Single sessions have helped many individuals and families and we hope that you have a similar experience.

    I/We understand and consent to the above counselling and service conditions.

    Demographic Information

    You are registering for a couples session. Please enter your partner's information:

    Please continue entering your information:





    Risk Assessment Summary

    Addictions (alcohol, drugs, gambling)Intimate partner or family violenceSexual assaultDevelopmental disabilitiesFinancial problemsWork or interpersonal conflictRisk to self or other

    Intimate Justice Scale

    Please rate each statement on a scale of 1 to 5 (1 means “I do not agree at all” and 5 means “I strongly agree”).
    Your answers are confidential and will not be shared with your partner.