Intake Form

Please complete the counselling intake form. This helps us understand your needs and prepare intentionally for your session. If you have any questions, feel free to contact us.

Email

Phone

First Name

Last Name

Email Address

Phone Number

Date of Birth

Relationship Status

Have you received counselling or therapy before?

In your own words, what is the main reason you are seeking counselling right now?

What is the ONE thing you most hope to walk away with from your session(s)?

Consent & Acknowledgement

I consent to The OA-Dynasty Group Inc. collecting, storing, and using the information provided in this counselling intake form for assessment, communication, and service preparation purposes. I understand that submitting this form does not establish a formal counselling relationship until confirmed by The OA-Dynasty Group Inc.