Intake Information Form-Individuals

Before booking your session, I ask that you complete this intake form and agree to the terms and conditions. After reviewing the form I will contact you by phone or email within the next 48hours. My preference is to speak with you by phone to get a snapshot of what is bothering you, discuss options and to implement next steps.

Tom Burton Counselling

Call

(587) 372-5638

Address

7718 104th  Street

Suite 201

Edmonton

Alberta

T6E 4C5

Email

tburtontherapy@gmail.com