Book An Appointment

Youth (ages 13-25) Intake Assessment

Is the youth or yourself at high risk today?

If Yes, then please contact Ministry for Child and Youth Mental Health (250) 861-7301,
Adult Mental Health (250) 868-7788, Crisis Line 1-888-353-2273
or the Adolescent Psychiatric Unit at Kelowna General Hospital (250) 862-4346
as we are not an emergency counseling service. Thank you.

General Information:

Youth's Date of Birth:


Youth’s First and Last Name:



Postal Code:

What number should we call to book appointments?

Secondary or Emergency Contact numbers:




Parent(s) Cell:

Your Email or Parent's email address to confirm appointments:

If Under 19 - Indicate the Parent(s) or Gaurdian(s) who live with you, separated by comma:

Who referred you to reach out?

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