Contact | Alongside You

CONTACT US

Contact Us

Who are these services for?*
Name of the person who these services are for*
First Last
What is the age of this person?*
Please enter their age as a number.
My relationship to this person*
I am their:
My name*
First Last
My Email*
Enter Email Confirm Email
Warning!*
If you have a Hotmail/Outlook/Live.com email address our response may go straight to your spam folder. Please check for it there, and add us (office@alongsideyou.ca & info@alongsideyou.ca) as an approved sender to avoid this issue. Otherwise it may appear as if we aren’t responding!
My Phone
Do we have your permission to leave a voicemail at this number?
Which services are you interested in?*
- Counselling
- Neurofeedback
- Registered Massage Therapy
- DBT Group
- DBT Individual
- Arts in Health
- Professional Training
Clients 12 years and under:
I understand that the first counselling appointment for children 12 or under must be attended by parents/caregivers only, and that the child will not attend until the second appointment.
Do you have any preferences for your clinician?
Would you prefer to receive your counselling in person at our Ladner clinic or online by secure telehealth video?*
What province or territory do you reside in?*
Please note we may not be able to provide services in all Canadian provinces or territories, or outside of Canada. We will let you know if we are unable to provide services to your region.
What form of Neurofeedback are you interested in?
I can be available for appointments:
Availability is limited after 3:00 and 5:00PM. (All times are Pacific Standard Time.)
Is there a separation involved for the caregivers of this child?*
We take the care of children very seriously at our clinic, and in the case of a caregiver separation we want to ensure the child’s access to treatment will be protected. We will be in touch with more details in order to help set this up.
Do you have an active claim with a third party insurer?
This does NOT include typical extended health care benefits. (It does however include groups such as the Autism Funding Branch, Crime Victim Assistance Program, First Nations Health Authority, etc.)
Insurer Name and Claim Number:*
If you have an active claim, please provide the name of your third party insurer, and a reference number for your claim.
Additional Information
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