Get Canada Conexus Counselling Client Intake Form 2020-2025

Completing the Canada Conexus Counselling Client Intake Form is an essential first step in receiving support and services. This guide will walk you through each section of the form, ensuring you have a clear understanding of the information required to assist in your consultation process.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it for online completion.
2. Begin by entering your personal information in the designated fields, including your full name, date of birth, current address, postal code, and age. Also, provide your home phone number and indicate if you are comfortable with receiving messages at this number.
3. In the contact information section, you will need to provide an alternative or work phone number and specify your preference for receiving messages. If you choose to share your email address, you may do so in the optional field provided.
4. Fill in your occupation or profession, and if currently unemployed, give a brief description of your situation. Indicate your highest level of education, as well as your religious upbringing and current affiliation.
5. Provide details regarding your marital status, including the number of marriages and your partner's name if applicable. Specify if you are currently living with a partner, and their education level.
6. List information about your children and dependents. For each child or dependent, provide their name, relationship to you, date of birth, and age.
7. In the family information section, share where you were born and list your siblings along with their ages. Identify if your parents are alive and include their professions, relationships to you, and living arrangements.
8. Indicate whether your parents are divorced and provide relevant details if applicable, including the year of the divorce and your age at that time.
9. Complete the general medical condition section by providing your family physician's name and an emergency contact. Specify any medical conditions you have, including sleep issues or other health concerns.
10. Detail your mental health history, including any past diagnoses and experiences of suicidality or self-harm. Mention any family member’s mental health issues if applicable.
11. Document any previous professional mental health assistance you have received, including the name of the professional, the reason for service, and the outcome.
12. State your reasons for seeking counseling and outline the issues you would like to address. Finally, provide the relevant dates if necessary.
13. After filling in all sections of the form, review your answers carefully for accuracy. You can then save your changes, download the completed form, print it, or share it as needed.

Start filling out your Canada Conexus Counselling Client Intake Form online today!