Moving Forward Family Services
REFERRAL / SELF-REFERRAL
Please be advised that there are potential risks and benefits associated with any form of therapy and positive results from therapy cannot be guaranteed or assured.
Do You require URGENT care? Health Authorities, provincial Ministries and School Districts provide urgent and short-term care in British Columbia. Consider accessing these services if in need of urgent care: (while some services offer drop-in, if possible, try calling first as hours may change due to Covid-19). For a list of urgent care services please visit the resources page of our website at https://movingforward.help/get-started under the 'Help Directory' Tab
NOTE: We are not funded by Health Authorities, MCFD, School Districts or Corrections - government ministries that are responsible for publicly funded counselling - therefore we can only offer a limited number of free sessions (up to 4) - and these are reserved for clients who are not employed.
Do you want to connect with someone today? Call Wellness Together
Phone. Call 1-866-585-0445 (Adults) or 1-888-668-6810 (Youth)Text (SMS). Text WELLNESS to 741741 (Adults) or 686868 (Youth) to connect with a trained crisis responder for support
https://wellnesstogether.ca/en-CA
Other resources: https://www.heretohelp.bc.ca/get-help
NOTE: As our services are provided by students and newer counsellors, be advised that anyone with complex needs may be better supported through other resources in the community
By completing this referral / self-referral the above client commits to attending appointments as scheduled and understands that multiple missed appointments may result in missed appointment fees and/or discontinuation of services
*Services for Children 12 Years of Age and Under
Services for children 12 years of age and under require consent from any and all legal guardians.
In cases where parents are separated or divorced, court rulings regarding custody or guardianship may limit the rights of one parent to take a child to see a counsellor without the consent of the other.
In completing this referral, you are agreeing that you either have the agreement of the other parent to bring your child to therapy or that you have the legal right to bring your child for therapy without the other parent’s consent.
Please note:
●We will not put the child(ren) in positions where they feel they have to speak out against one of their caregivers.
●We do not provide assessments for Family Court
●We will not provide letters that are critical of the other caregiver’s parenting.
By submitting this referral request for counselling for a child, you understand and accept the above information and confirm that you are legally entitled to provide consent for child therapy.
Making a false claim around guardianship may adversely impact current or future custody/family court matters
Why do we ask for fees?
While we receive numerous referrals from Health Authority sites, MCFD, Probation and Schools (who are responsible for publicly funded mental health and addiction counselling/psycho-education services), we are not funded by any of these groups - thus rely on fees to help cover our operating costs. There is benefit in not being funded by such sources - in that we do not have to limit who we serve based on age, identified gender, presenting issue, geography, bureaucracy yet in order to remain sustainable, we need to ask for fees ... therefore if you are looking for free services please contact those government service providers.
We also ask you to consider the fees as an investment in your own well-being in addition to helping sustain our services.
At the same time we recognize the private system is financially out of reach for most who need it.
We therefore see ourselves as a hybrid - taking the best of both systems in efforts to provide a low barrier, quality and sustainable service for our diverse communities.
What option is best?
TO REFERRAL AGENCY (if applicable)
Please ensure you have advised your client of the various services (and fees) and advise client that multiple missed missed appointments may result in missed appointment fees and/or discontinuation of services. Note as well we will make up to two efforts to contact client and if client does not reply back we will close referral. In the rare instance that client claims no one has called them within the wait times listed above, ask them to call 778-321-3054. Furthermore, we ask you to continue to look for additional resources for your referred clients in addition to the services we may be able to offer. If you are referring client for 'pay what you can' you should first explore funded services offered by MCFD, Health Authority, Corrections and School Districts. Please note if referring to interns: that while our students on practicum are insured and supervised, they are trainees - clients access our services as they have not been able to access publicly funded services and cannot afford traditional private therapy rates. As trainees, our interns are not in a position to diagnose or assess, nor offer any clinical opinions.
If you are a referral agency, consider sponsoring your low income/no income client's therapy as we are not funded by the ministries responsible for publicly funded counselling (Health Authorities, MCFD, Education through School District, Corrections). Email counsellor@movingforwardfamilyservices.com to learn more about how your organization can sponsor a client's therapy. You can also donate to support our low barrier services and receive a taxable receipt
*By submitting this form I acknowledge I have reviewed the "For Clients" and/or "For Service Providers" tab (if applicable) found on the website
Our Privacy and Confidentiality Policies: As part of our work together, we will collect personal information about you for the purposes of providing consultation, counselling or referral services. This information may include current concerns, relevant history and family information. Such information will be kept safely stored in a secured location. Relevant information may be shared between counsellors and counselling supervisors for the purpose of professional consultation and with administrative staff as related to managing files. While your information is confidential, there are legal exceptions to confidentiality. While rare, these situations include: where such information is required to assess the possibility of/to prevent a life-threatening situation, whether it pertains to a client or a third party; when there is concern that a client may not have the capacity to identify when a situation is harmful; when there is evidence or suspicion that a child is, or may be, in need of protection; for the purpose of a legal proceeding, court order, or other legal requirement. Clients may be given supervised access to their file if requested. The client has the right to receive explanation of any information in the file, and to include documentation regarding any information they may feel is inaccurate. Any questions or concerns regarding Counselling and Support Services’ Privacy and Confidentiality practices may be directed to Clinic Supervisor Gary Thandi, MSW RSW at counsellor@movingforwardfamilyservices.com or at 778-321-3054
*Services for Children 12 Years of Age and Under
Services for children 12 years of age and under require consent from any and all legal guardians.
In cases where parents are separated or divorced, court rulings regarding custody or guardianship may limit the rights of one parent to take a child to see a counsellor without the consent of the other.
In completing this referral, you are agreeing that you either have the agreement of the other parent to bring your child to therapy or that you have the legal right to bring your child for therapy without the other parent’s consent.
Please note:
●We will not put the child(ren) in positions where they feel they have to speak out against one of their caregivers.
●We do not provide assessments for Family Court
●We will not provide letters that are critical of the other caregiver’s parenting.
By submitting this referral request for counselling for a child, you understand and accept the above information and confirm that you are legally entitled to provide consent for child therapy.
Making a false claim around guardianship may adversely impact current or future custody/family court matters
Your information will be encrypted.