Intake Process

Thank-you for your interest in pursuing therapy services with Christian Counselling Ottawa.

We are currently accepting new intakes for individuals aged 13 and up and also for couples. If you are seeking a subsidy, the wait time will be dependent upon the availability of funds in our Subsidy Program. Wait times vary by therapist and format (online vs. in person).

Form not available at this time: Once you have filled in the following information, our Intake Coordinator will be in touch via email (unless otherwise requested) to confirm fees and send you the intake forms to complete. Upon completion of the forms, you will be assigned to a therapist.

Please note that this is not a crisis service.
If this is an emergency, please dial 911.
Should you require immediate intervention, please contact:

Ottawa Mental Health Crisis Line at (613) 722-6914
Distress Centre of Ottawa Distress Line at (613) 238-3311
Wellness Together Canada – text 741741

For clergy members in crisis, you can connect with a counsellor through Focus on the Family's Clergy Care at 1-888-525-3749 or email [email protected]

If you would prefer to reach out to us directly, our Intake Coordinator can be reached by phone at 613-729-8454 or by email at [email protected]

CCO Intake Questionnaire

"*" indicates required fields

To ensure we communicate all the details to you, our Intake Coordinator will connect with you via email. Your assigned therapist will do the same. If you prefer your therapist to contact you by phone, please click below.*

Name*

First Last

Phone Number

Email Address*

Address*

Street Address City State / Province / Region

Are there any confidentiality concerns when leaving messages?*

Are you a returning client of CCO?*

Are you requesting individual, or couples counselling?*

Are you interested in Gottman Method Couples Therapy?*

Please provide the contact details for the other participant

Name

First Last

Phone Number

Email Address

Did you receive a referral for Psychotherapy or Social Work Services?*

Yes

Provider's Name

If you selected 'yes' above, please provide the contact details for the referring provider.

First Last

Provider's Phone Number

Would you prefer in-person or online sessions? (NOTE: In-person availability is limited and may affect wait times)*

Please note the specific location of therapists when selecting your preferences below as not all therapists work from the main office

In-person only

Online only

In-person or online

Would you be interested in seeing an Intern? (NOTE: Interns are followed closely by our Clinical Director, and are subject to approval according to needs)*

Yes

I would like more information on Interns

Do you have any accessibility needs? Describe below if so:

What is the main reason you are seeking counselling?*

**Please note that this is not a crisis service. If this is an emergency, please dial 911. Should you require immediate intervention, please contact: Ottawa Mental Health Crisis Line at (613) 722-6914

My first choice for a therapist is:

Before selecting a therapist, please check HERE to view availability (online vs in person), and specific services offered. While every effort will be made to match you with your preferred therapist, requests cannot be guaranteed.

My second choice for a therapist is:

My first choice for a therapist is:

In person therapists shown only, based on your preference for in person sessions. Please check HERE to view availability (online vs in person), and specific services offered, or change your selection above to choose from our full range of therapists. While every effort will be made to match you with your preferred therapist, requests cannot be guaranteed.

My second choice for a therapist is:

My first choice for a therapist is:

Couples therapists shown only, based on your preference for Couples Counselling. Please check HERE to view availability (online vs in person), and specific services offered. While every effort will be made to match you with your preferred therapist, requests cannot be guaranteed.

My second choice for a therapist is:

My first choice for a therapist is:

In person couples therapists shown only, based on your preference for Couples Counselling and in person sessions. Please check HERE to view availability (online vs in person), and specific services offered, or change your selection above to choose from our full range of therapists. While every effort will be made to match you with your preferred therapist, requests cannot be guaranteed. *Please note, there is a wait time for In-Person Couple's Counselling. Please select virtual sessions for quicker start times.

My second choice for a therapist is:

When are you available?*

Monday morning

Monday afternoon

Monday evening

Tuesday morning

Tuesday afternoon

Tuesday evening

Wednesday morning

Wednesday afternoon

Wednesday evening

Thursday morning

Thursday afternoon

Thursday evening

Friday morning

Friday afternoon

Age Range*

13-15

16-17

18-24

25-34

35-44

45-54

55-64

65 or Above

Prefer Not to Answer

How did you hear about Christian Counselling Ottawa?*

Church

Social Media

A Friend

Radio Advertising

Web Search

Other

Would you Like to receive our newsletter and other information from CCO?*

Please Note: By clicking 'YES', you are giving consent to receive our monthly newsletter and other special communications from Christian Counselling Ottawa. We do not share our email lists with any other organization.

Session fees are established using a sliding scale based on your Total Household Income and the number of people living off that income. There is no HST charged. Your method of payment (eg. Insurance, church subsidy) does not affect the fee calculation.

If you would prefer to discuss these details with our Intake Coordinator please choose here

Yes

Our Intake Coordinator can be reached by phone at 613-729-8454 every weekday morning (9:30-12:30) except Thursday (1:00-4:00PM)

What is your gross household income?*

How many people are living off that income?*

Insurance benefits coverage*

If you are unsure about whether your insurance covers our services, please contact your employer or benefits provider. Please note that our practice is currently supervised by Registered Psychotherapists. We do not have a supervising psychologist. Most insurance companies accept this arrangement – please confirm with your own insurance company. If you are hoping to use an EAP, please contact your EAP representative to determine eligibility and to receive a referral if needed.

This field is for validation purposes and should be left unchanged.

Intake Process

CCO Intake Questionnaire

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