CROSSROADS COLLECTIVE

Initial Inquiry Form

Individual's First Name

Individual's Last Name

Email Address

Phone Number

Date of Birth of Person Completing This Form

Preferred contact method:

Phone

Do you consent to receiving text message reminders for your appointments?

Yes

In person, online/virtual, or telephone call

In-Person

Online/Virtual

Phone Call

Which location?

Langley

Kelowna

Do you prefer a Female or Male Counselor?

What type of counselling/services are you seeking?

Individual

Couples/Relationship Counselling

Family Counselling

Divorce and Separation

Child and Youth Counselling or Play Therapy

Family Mediation

Co-Parent Counselling/Support

Family Systems Support Program

What time of day do you prefer?

Child's parents together or separated?

Has a child protection agency been involved with your family?

Yes

If yes, please explain:

Has a law enforcement agency been involved with your family?

Yes

If yes, please explain:

Has there been a court order regarding your children, your co-parent and/or yourself?

Yes

If yes, please explain:

Is there currently a peace order or protection order in place with your children, yourself and/or your co-parent?

Yes

If yes, please explain:

Are there any accommodations or needs that would help us to support you that you feel comfortable sharing?

Yes

If yes, please explain:

Child's First Name:

Child's Last Name:

Date of Birth of Child

Child's diagnosis (if any):

Do you have extended health insurance?

If you do not have extended health coverage for counselling, we have a few options on who we could pair you with. Please click one or more depending on your preference:

A registered clinical counsellor or registered social worker with a rate of $165-$185+GST per session.

An associate counsellor, who has graduated with a Masters in Counselling Psychology and awaiting their full license with a rate of $100+GST per session

An intern counsellor supervised by a registered clinical counsellor with a rate of $50+GST per session.

EXTENDED HEALTH BENEFITS

It is very important you check your insurance coverage on your portal, online or brochures provided by your insurance company. Since Covid, many insurance companies now cover both Registered Clinical Counselors and Registered Social Workers as they are considered the same qualifications. Social Workers and Registered Clinical Counselors are both trained and specialize in counselling despite the name looking different they do the same clinical work.

What’s the difference between a Registered Social Worker (RSW) and a Registered Clinical Counsellor (RCC)?

The main difference lies in their education and regulatory body:

RSWs (Registered Social Workers) have a bachelor’s or master’s degree in social work and are regulated by the BC College of Social Workers (BCCSW).
RCCs (Registered Clinical Counsellors) have a master’s degree in counselling psychology and are registered with the BC Association of Clinical Counsellors (BCACC).

Even though they’re registered with different organizations, both have similar levels of education, training, and clinical experience, and they provide the same kind of Counselling support and value in therapy.

We have both Registered Clinical Counselors and Registered Social Workers on staff and in order to match you with the best fit please look at your insurance documentation and carefully choose the options below as it will make a huge difference who we recommend based on your needs and avoid several emails back and forth with you and we can book you in sooner with the best fit for you or your loved one.

What is your coverage for?

Registered Social Workers(RSW)

Yes

Registered Clinical Counsellors with the BCACC (RCC) and the CCPA (CCC)

Yes

Registered Professional Counsellors with the CPCA and ACCT (RPC)

Yes

Other additional funding:

What are your needs for counselling and how can a counsellor help?

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If you have questions, please contact us directly

Langley: (604) 532-5340

Kelowna: (250) 765 0606

E mail: info.crossroadscollective@gmail.com