Prior to your first appointment, please download and complete an Intake Form and Consent Form.
These forms are fillable on a desktop computer and can be saved and emailed directly to us.
Complete the following forms prior to your first appointment.
Save Your Form as “(Your Name) Intake Form" using one of the two methods:
Scroll to the top of the form and choose the download icon on the top right of your browser window
Or, right-click and select ‘Save As’.
Once complete, email the form as an attachment to firstname.lastname@example.org.
Questions about how to send this form? Text or call us at 905-321-0550.
- If you have extended health benefits for a Registered Psychologist, use Option 1.
- If you have extended health benefits for a Registered Psychotherapist or Social Worker, use Option 2.
- If you are not claiming our services through health benefits, use Option 3.
Use these forms if you are claiming our services under a benefit plan that covers a "Registered Psychologist":
Use these forms if you are claiming our services under a benefit plan that covers a"Registered Psychotherapist" or "Registered Social Worker"
Use these forms if you are not claiming our services under a benefit plan.
COVID-19 Consent Form
If you are meeting in-person at our office, please sign the following consent form and bring it with you to your first appointment:
COVID-19 Safety Protocols
As we move through stages of re-opening, Abma Counselling Services is committed to following the advice of Public Health authorities in order to help slow the spread of the virus and to protect the safety of our clients and therapists. At our office, we have implemented the following elimination, engineering and administrative measures:
What we are doing:
· Screening clients before each appointment. If a client has travelled outside of Ontario in the previous 14 days, has symptoms of COVID-19, or has been in close proximity of someone who has confirmed or suspected COVID-19, we will reschedule or change the in-person appointment to a phone or video session.
· Waiving fees for late cancellations due to COVID-19.
· Posting signs for COVID-19 screening.
· Limiting the number of in-person sessions and staggering appointments to reduce the number of people in the office.·
· Asking clients to not use the waiting room seating area.
· Arranging office furniture to ensure that client and therapist are at least 2m (6ft) apart.
· Removing non-essential items from common areas such as candy, pens, magazines, cups, etc.
· Ensuring physical distancing throughout the appointment visit.
· Providing alcohol-based hand sanitizers upon entry and exit.
· Providing tissues and non-touch lined garbages.
· Installing portable HEPA air filter units in each counselling office.
· Cleaning and disinfecting high-touch surfaces (e.g. pens, door handles, garbage bins, light switches, taps, furniture, etc.) and restrooms in between each appointment.
What we are asking our clients to do:
Prior to your appointment
· If you have travelled outside of Ontario in the previous 14 days, have symptoms of COVID-19, or have been in close proximity of someone who has confirmed or suspected COVID-19, contact us to reschedule or change your in-person appointment to a phone or video session.
· Bring your own beverage.
· If you wish to wear a mask, please bring your own. Therapists will also have masks available for their own use, and will be ready to wear a mask if needed.
- Your therapist will send you a text message with a COVID-19 Screening Test. You will be asked if you currently have any COVID-19 symptoms and if, in the last 14 days, you have travelled outside of Ontario or have been in contact with anyone who has confirmed or suspected COVID-19.
Arriving at your appointment
· Please wait at your vehicle.
· If you have completed your COVID-19 Screening, your therapist will review your answers.
If you answer "Yes" to any question, your therapist will either reschedule your appointment or arrange to meet by phone or video.
If you answer "No" to all questions, your therapist will contact you when s/he is ready to meet you at the entrance to our building.
During your appointment
· When entering the office, please use the hand sanitizer available in your therapist’s office and the reception desk.
· Maintain a distance of at least 2m (6ft) from your therapist and any other individuals.
· If you choose to wear a mask, your therapist will offer to wear one as well.
Please contact us at 905-321-0550 if you have any questions about these measures.
We welcome the return of face-to-face counselling and are committed to providing a safe and comfortable space for everyone who comes to our office.