Ready to start your healing journey?
Fill out the intake form below.
About the Intake Form:
Niagara Life Centre uses the information provided in this form to determine our ability to provide suitable services for the needs you identify. By completing this form you will have officially signed up for our counselling services and will be added to our wait list. It is important that the information you share is accurate and provides details regarding specific experiences you are seeking support for.
This form may only be filled out by the individual identified on the form. If you are signing up for couples or family counselling, each member will be required to submit a separate intake form (please identify the person you wish to receive these services with in the indicated fields below).
At this time, Niagara Life Centre is only able to offer services to those ages 18+.
If you have questions or concerns regarding our online intake process, please call the office at 905 934 0021.
