CROSSROADS COLLECTIVE

Initial Inquiry Form

Initial Inquiry Form
Preferred contact method:
Do you consent to receiving text message reminders for your appointments?
In person, online/virtual, or telephone call
Which location?
What days of the week work best for you?
What type of counselling/services are you seeking?
Has a child protection agency been involved with your family?
Has a law enforcement agency been involved with your family?
Has there been a court order regarding your children, your co-parent and/or yourself?
Is there currently a peace order or protection order in place with your children, yourself and/or your co-parent?
Are there any accommodations or needs that would help us to support you that you feel comfortable sharing?

What is your coverage for?

Registered Social Workers(RSW)
Registered Clinical Counsellors with the BCACC (RCC) and the CCPA (CCC)
Registered Professional Counsellors with the CPCA and ACCT (RPC)
Registered Therapeutic Counsellors with the ACCT (RTC)
Additional funding:

If you have questions, please contact us directly

Langley: (604) 532-5340

Kelowna: (250) 765 0606 

Email: info.crossroadscollective@gmail.com

Google Rating
4.5
Based on 105 reviews
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