Counselling Service Request Form

Moving Forward offers free short-term and affordable long-term counselling options to underserved communities across Canada via in-person, telephone, and online platforms. We welcome you to our judgment-free environment where you can get the help you need no matter your age, race, identified gender, financial situation, or location. Please fill out the form below. Note we operate with minimal waits however with holiday season there may some delays in follow-up

Please correct the errors described below.

COUNSELLING SERVICE OPTIONS - Please choose either services with Intern (Student on a practicum) OR Registered Therapist. Sessions are 50 minutes.

Health Authorities, Education, Corrections and Ministry of Children and Family Development are responsible for publicly-funded counselling, and we do not receive any funding from those sources. We therefore operate on cost recovery. Because we are not funded by government sectors responsible for publicly-funded counselling, we can only offer up to 4 free sessions with an intern - and only to clients who are unemployed. If you work, you would be expected to pay for services. Note that missed sessions without advance notice may incur fees / count towards free sessions, and 2 missed sessions may result in discontinuation of services.

In-person services have minimum fees attached (as there are considerably higher costs associated with in-person services such as space, maintenance and fuel to and from office).

Once a counsellor is assigned, they will call you and if possible, leave a message, as well as attempt to contact you through email; they will wait one week for a reply and then move onto other clients on the wait list - this practice ensures we are following up with counselling service requests as quickly as possible.

PLEASE stop and review your selections above - to ensure you only selected ONE option.

Choosing multiple options will delay response times (as it requires us to follow up to clarify which the options).

Also please ensure you have read each option (and its associated wait times carefully).

By submitting form, I acknowledge the following:

I acknowledge that certain services may only be available to me if I am a low income earner. I understand I may be required to provide proof of low income. If choosing to see an intern, I acknowledge that I have not been able to access services through the agencies responsible for publicly funded counselling. I understand that these services have a maximum number of sessions (will be reviewed at 12 sessions).

I am aware there are waits based on service I chose - and that the therapist will attempt to call me as well as email me, and that if I do not follow up within one week that the file may be closed.

When a client is at risk for or has attempted suicide, and a Moving Forward Family Services Society staff member becomes aware of this, the staff member will do the following:

1) Promptly disclose this information to their Clinical Supervisor, Manager and the Executive Director

2) Provide an assessment of the situation

3) Determine the risk of danger to others: this encompasses family members, acquaintances, and the client

4) In the circumstance in which the client is a minor the staff member will initiate contact with the minor’s parent or guardian and appropriate ministries if applicable.

5) In the occurrence of an attempt of suicide, a contact to the local authority will be made and appraisal of the situation will be disseminated to the authority

6) If required call an ambulance or contact an appropriate agency for crisis intervention

7) Ensure highest measure of confidentiality by only initiating contact with other agencies on a need to know basis such as school officials, counselors, mental health professionals, or family physician.

8) In collaboration with all involved professions institute a follow up procedure to ensure a level of communication exists among all personnel

9) Supervisor is notified as soon as possible

I understand that if I am choosing a service with an intern, they may have limited prior experience and cannot offer specialized services, such as psychological assessment. They also will not provide detailed letters for court/probation/social worker.

Once an appointment is made, I will make every effort to attend. I will provide a minimum of 24-hours advance notice if I cannot attend. I understand that missed appointment fees may be charged and/or services will be discontinued if I miss multiple (two or more) appointments.

I understand that while services are offered across Canada, MFFS is based in British Columbia, Canada, and follows provincial laws related to service agencies.

I understand that services are fee-based, with limited free services reserved for those who do not work

I understand Moving Forward Family Services will deny services to anyone who acts aggressively (physically or verbally) towards our team

I understand Moving Forward Family Services will deny services to anyone who expresses views that contradict human rights as outlined in the BC and Canadian Human Rights Code

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