NEW CLIENT INQUIRY FORM

Please fill out the form below. This form is designed to help us gain a better understanding of who you are and your reason for seeking counselling. Gathering this information helps us to connect you with a counsellor who is the best fit for you. Once completed, you can expect a reply from us in 2-4 business days. Please contact us at admin@embodycounselling.ca with any questions or concerns.

if you do not receive an email from us in 2-4 business days please check your junk folder

Name

First Name

Last Name

Demographic

The requested counselling is for:

Child/youth (14-18)

Adult (19+)

Couple

If you are requesting counselling services for your child/youth, please provide their name and age:

Reason for Counselling

Please briefly describe the reason that you are seeking out counselling services at this time. This helps us connect you with a counsellor who will be able to best support you.

Counsellor Preference

Who do you want to work with?

Leanne Weenk

Kathryn Hall

No preference

Preferred Appointment Times

Please indicate which days and times you are available for counselling. Counsellor availability varies.

EMBODY COUNSELLING

ABOUT US

Embody Counselling is a counselling practice located in downtown Langley, BC. We are a team of compassionate and dedicated Registered Clinical Counsellors who strive to create a space where our clients will feel seen, heard and supported. Our counsellors work with youth, couples and adults.

CONTACT EMBODY COUNSELLING

20627 Fraser Hwy, Langley, BC v3A 4G4

phone: 604-546-1522

email: admin@embodycounselling.ca

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We respectfully acknowledge that we live and work within the ancestral, traditional, and unceded territory of the Coast Salish Peoples, including the territories of the q̓ic̓əy̓ (Katzie), q̓ʷɑ:n̓ƛ̓ən̓ (Kwantlen), Máthxwi (Matsqui) and se’mya’me (Semiahmoo) First Nations.