Request Access for Affordable Counselling

We believe financial barriers should not prevent people from accessing meaningful mental health support. If you are interested in one of our limited affordable counselling appointments, please complete the short form below. This secure form helps us understand whether a reduced-fee appointment may be available and allows us to respond with next steps.

Please do not include detailed personal health information, sensitive history, or urgent concerns in this form.

Affordable appointments are limited and offered based on availability. If a reduced-fee space is not currently available, you may be offered the option to join our waitlist or explore other available supports.

Your Information

Full Name

Phone number

Preferred Method of Contact

Email Phone Both

I consent to receive email communication from Origin Counselling regarding my request for affordable counselling options and potential next steps.

If you prefer not to communicate by email, you are welcome to book a free 15-minute consultation where we can discuss affordable counselling options.

Counselling Needs

How would accessing a sliding-scale rate support you at this time?

Next Steps

If a sliding-scale spot is available, how would you prefer to move forward?

I would like to book an appointment if a spot is available I would like to book a free 15-minute consultation to see if counselling is the right fit I would like to receive more information before deciding

Consent & Important Information

I understand that Origin Counselling is not a crisis support service. If I am in immediate danger, I will call 911. If I am experiencing thoughts of suicide or am in crisis, I will call or text 988 to reach the Suicide Crisis Helpline, available 24 hours a day across Canada.

I understand that submitting this request form does not guarantee access to a reduced-fee counselling appointment.

Affordable counselling spaces are limited and offered based on current availability.

Privacy Notice:
The information provided through this form will only be used to review your request for affordable counselling services and communicate with you regarding availability and next steps. Your information will be handled according to Origin Counselling’s privacy practices.

Thank you for taking this step toward accessing support. We review each request with care and will respond by email within 2 business days regarding availability and next steps. Affordable counselling spaces are limited, but we will do our best to support you with the options currently available.

Your information will be encrypted.