Counselling Service Request Form

Note: if you are referring a client (whether as a referring agency, or if you are family member): to ensure our long-term sustainability, we request that you explore the possibility of covering the fees if the client cannot afford to pay. Alternatively, please thoroughly explain the service options (and related fees)

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

Health Authorities, Education, Corrections, Post-Secondary Education, 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.

While we do our best to address the massive gaps in services around mental health care, we may not be the best fit for your needs - especially since our interns and registered therapists offering the lowest fee services are newer practitioners. In such cases, we encourage you to look for other options in the community.

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 note that for any services provided by interns: our interns will not provide reports, assessments, or diagnoses. If your case involves pending/recent family/criminal court, employment, litigation, ICBC, and complex matters consider requesting more experienced registered therapists.

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.

Section 1 - Choose one of these options if you are low income/have no income, and have no insurance coverage. Choosing multiple options will slow down the time it takes to assign the therapist

Section 2 - Choose one of these options if you are a low income earner but want to work with a private registered therapist who offers reduced fee services for low income clients. Note: proof of low income may be required by the therapist. This service under these fees is not eligible for insurance. To prevent someone from using insurance at these rates, any receipts requested will not have information required for insurance reimbursement - such as registration number of the therapist, their address, etc.

Section 3 - Choose one of these options if you are a high income earner, have insurance, or have funding through ICBC or Crime Victim Assistance Program. Choosing multiple options will slow down the time it takes to assign the therapist. Therapist may initially reach out by email so please keep an eye out (and also check your spam/junk folder)

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).

Section 4

ADDITIONAL SERVICES:

Coaching and Group Programs:

We offer numerous additional services to support our communities' well-being. We suggest wherever possible to engage in therapy as well as accessing psycho-educational coaching support and attending group.

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) and would be reviewed by supervisor to determine if any extensions are provided

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

I understand that while Moving Forward Family Services is a low barrier service, it may not address all of my needs, and thus will continue to explore other options (public sector and/or private)

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. A basic letter outlining number of sessions and generally what was discussed in sessions can be provided free of charge - such a letter must be requested a minimum of four weeks before it is required. Any request made with a shorter deadline will be subject to an administration fee of $50. While a basic letter can be provided free of charge, a request for the complete client file will be charged a minimum administration fee of $75.

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. If a service is discontinued due to missing multiple sessions, an administration fee to reactivate file of $20 will be administered.

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 that Moving Forward Family Services reserve the right to refuse service to anyone who engages in aggressive behaviour (yelling, profanity) derogatory language towards the therapist/social worker, or anyone who consistently books appointments and then does not show.

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

I understand that Moving Forward Family Services reserve the right to refuse services to anyone who makes demands for services we cannot provide and continues to make such demands (i.e. someone wanting an experienced therapist with specializations, but only wanting a free service).

That if I have not heard back after the approximate wait time, I can email gary@movingforward.help to check on status of my file

Moving Forward Family Services

Informed Consent – Risks and Considerations of Therapy

Counselling and therapy can be important steps toward healing, growth, and improved well-being. Like any process of personal change, they can also involve challenges and risks. The experience will vary depending on your needs, the issues being addressed, and the approach used. The purpose of this document is to outline common considerations so you can make informed choices and work collaboratively with your counsellor toward safe, ethical, and effective care.

Please read the following information carefully and speak with your counsellor about any concerns or questions you may have.

1. Working with Intern Counsellors

At Moving Forward Family Services, most clients work with counselling interns who are completing undergraduate or graduate-level training. These interns are developing their counselling skills under the regular supervision of qualified clinical supervisors. This supervision is in place to support quality of care and professional growth. You are encouraged to ask about your counsellor’s training, supervision process, and professional development.

2. Emotional Discomfort and Exposure

Therapy often involves exploring difficult feelings, thoughts, memories, or relationship patterns. These discussions may bring up discomfort, sadness, anxiety, or other strong emotions. Some approaches involve directly facing distressing material, which can temporarily increase emotional strain before improvement occurs. While avoidance is a natural protective response, therapy may gently challenge it to promote healing. Your counsellor will work with you to move at a pace that feels safe and manageable.

3. Processing Between Sessions

It is common for thoughts, dreams, emotions, and body sensations to continue emerging after a session. You may notice shifts in mood, recall new memories, or experience changes in sleep. This is a natural part of the mind integrating therapeutic work. Sometimes you may feel worse before you feel better. Setting aside time for rest, reflection, and self-care after sessions can help. Remember that what happens between sessions—your reflection, practice, and self-awareness—is just as important as the session itself.

4. Risk of Symptom Fluctuation or Relapse

Therapy can uncover emotions or patterns that were previously suppressed. As a result, you may temporarily experience increases in anxiety, sadness, irritability, cravings, or urges. In some cases, there may be a risk of relapses for issues such as substance use, self-harm, disordered eating, or panic attacks; especially if stress rises before coping strategies are fully developed. If you have a history of relapses or fluctuating symptoms, let your counsellor know so you can plan additional supports together.

5. Trauma Work, Medical Concerns, and Legal Implications

Trauma-focused therapies, such as EMDR or memory-based processing, can evoke strong emotional or physical responses. If you have significant medical conditions (e.g., heart disease, seizures, stroke risk, high blood pressure), it is recommended you consult your physician before beginning intensive trauma work.
If you are involved in a legal case, especially as a victim or witness, be aware that trauma therapy can alter how memories are stored or recalled, which may affect testimony. In such cases, your counsellor may recommend delaying certain therapeutic techniques until it is safe to proceed.

6. Rapid or Major Life Changes

Therapy can lead to greater self-awareness, which may prompt changes in relationships, boundaries, work, or lifestyle. While these changes can be positive, making major decisions too quickly (such as ending relationships, quitting jobs, relocating, or confronting individuals), can create additional stress. Your counsellor can help you reflect on timing and pacing before acting on new insights.

7. Impact on Current Stability

If you are functioning well in daily life, opening up long-contained grief, trauma, or relational difficulties may temporarily reduce feelings of stability or control. Your counsellor will help you consider the timing and approach for this work, especially if you are balancing significant personal or professional responsibilities.

8. Ending Therapy

You have the right to pause or end therapy at any time. However, stopping abruptly, particularly during periods of distress—can leave you feeling unsupported or worsen symptoms. Thoughts of hopelessness or the belief that change is impossible can influence the decision to end therapy. Discussing these feelings with your counsellor may help you develop a safe, thoughtful plan for transition or closure.

9. Alternatives and Additional Supports

Therapy is one of many possible supports for mental health and well-being. Other options may include:
- Group therapy or support groups
- Coaching or mentoring
- Medical or psychiatric consultation
- Spiritual, cultural, or peer-based supports
- Self-help resources

MFFS does not provide diagnosis or prescribe medication, but your counsellor may suggest referrals or consultations as part of your care plan.

10. Important Final Notes

Not every therapeutic method works for everyone. You may benefit from preparation before starting certain types of therapy, or from a different approach entirely. Our aim is to provide care that is trauma-informed, inclusive, and respectful of your values, culture, and needs. You have the right to ask about what happens in sessions, treatment goals, and alternative approaches, and to participate fully in shaping your care.

Many of our counsellors are students supported by a network of supervisors and experienced practitioners across Canada. While they may not have immediate answers to complex questions, they can consult with supervisors and colleagues to identify appropriate tools and strategies. Your patience and openness during this process contributes to ethical, thoughtful care and supports their professional development.

Potential Risks to Be Aware Of

- Emotional Discomfort – Confronting painful emotions or memories can be challenging.

- Increased Vulnerability – Sharing personal information may leave you feeling exposed.

- Temporary Worsening of Symptoms – Some people experience a short-term increase in distress before improvement.

- Changes in Relationships – Growth may shift how you relate to others, sometimes affecting relationships.

- Risk of Self-Harm – Rarely, therapy may trigger thoughts of self-harm or suicide. Always share these thoughts with your counsellor immediately.

- Therapist Limitations – Like all professionals, therapists can make mistakes or may not be the right fit for your needs.

In Summary

Therapy can bring both discomfort and significant personal growth. You are in control of your pace, your participation, and your goals. Our role is to provide respectful, collaborative, and informed support as you work toward your well-being. If at any point you have concerns about the process, please communicate openly with your counsellor so that adjustments can be made in a way that suits your needs and values.

BEFORE YOU SUBMIT, please review submission

If requesting counselling: Have you chosen only one Counselling option ($20 service with an intern, 'pay what you can' with an intern, $50 with a registered therapist - for low income clients without insurance, or services with a registered therapist for $130-$150)? If you chose multiple options, our Clinical Supervisor would assign to the lowest priced service that was chosen (in which case, note the waits as listed).

If choosing coaching, please choose a maximum of two. Once one is completed, you can apply to accesss another coaching program.

In-person services have mimimum fees

If requesting services in another language, email hello@movingforward.help to check if we have current capacity