Healing Alliance Counselling
Appointment Request Form
Counselling is not for everyone, and often times it feels difficult, or even impossible, to reach out and ask for help. This being said, I would like to commend you on your courage to enter counselling at this time in your life, and thank you for allowing me to take part in your journey. By completing and submitting this form you are in no way obligated to enter counselling at this time. We will have a chance to discuss what brings you to counselling and whether it is the right fit for you prior to your first appointment. Once I receive your form, I will contact you within 48 hours, using the email you provided and request further contact information. This form will be sent directly to Jessica Taylor at Healing Alliance Counselling. You may wish to contact us directly by email and may do so by emailing firstname.lastname@example.org or by phone at 613-619-0402 or 613-435-9299 ext 4 and leave a confidential voice mail. Please note that both day and evening appointments are available.
If you are in need of immediate assistance please do not hesitate to contact the following crisis lines, available 24 hrs a day, 7 days a week:
Mental Health Crisis Line Distress Centre of Ottawa & Region
613-435-9299 ext 4