Counselling Referral Form

This form is to be filled out before your first visit with a counsellor. It will provide counsellors with your contact and health coverage information ahead of your visit. Please note that filling out this form will not make an appointment with the indicated counsellor. This form only needs to be completed for your first visit. 


*Required field


Did you opt out of the Student Health Plan?*


Are you an international student?*

Are you a CCP (adult upgrading) student?*


Submit