BE MATCHED WITH A COUNSELLOR AT NEW TIDES COUNSELLING AND WELLNESS Name * First Name Last Name Age Email * Phone (###) ### #### What counselling services are you interested in? Individual Counselling EMDR Therapy (note - EMDR can be done online) Art Therapy Couples Counselling CVAP funded counselling Low Cost Counselling with an Intern ($55) Are there any other holistic or group services you would also like to be contacted about? Breathwork Individual Counselling and Yoga 4 Week Making Sense of Trauma Group (Waitlist) Online Anxiety Program (Yoga, Mindfulness, Trauma-Informed Learning) Calm and Connected Events (In person yoga and connection in Vancouver) When are you typically available for counselling? Weekday mornings (9am-12pm) Weekday afternoons (12pm-4pm) Weekday early evenings (4pm-6pm) Weekday evenings (6pm-8pm) Saturdays and/or Sundays Is it important for you to be connected with counsellor who identifies with a specific gender? If so, please let us know below Are you open to online counselling sessions/ Prefer online only Prefer in person only Either in person or online Are you open to being placed on a waitlist with the counsellor best suited to you, or are you looking for immediate support? Immediate Support Would Consider Waitlist Unsure What concerns are you are looking for support with? Not a fan of lists? No problem... feel free to tell us a bit about what you're looking for support with in the text box at the bottom Anxiety Depression Self Worth Grief and Loss Body Image Challenges Relationship Challenges Trauma and / or PTSD Trauma: Complex Trauma Trauma: Medical Trauma Trauma: Sexual Assault/Abuse Trauma: Motor Vehicle Accident Substance Misuse or Addiction Challenges Concussion or Traumatic Brain Injury Disordered Eating (Please Specify) Dissociative Identity Disorder / DDNOS Borderline Personality Disorder Phobias (Please Specify) Anger Management Bipolar Disorder Suicidal Ideation Self-Harm Bunout OCD PCOS ADHD AuDHD Autism Chronic Pain / Illness Retirement / Senior Life Stage Gender / Sexual Identity Exploration LGBTQ+ Related Experiences & Challenges Transgender Related Experiences & Challenges Immigration & Refugee Related Experiences & Challenges Highly Sensitive Person Experiences & Challenges Indigenous Identity, Experiences & Challenges BIPOC Related Experiences & Challenged Challenges Related to Front Line Work Spiritual Exploration or Integration Post Secondary Support Psychedelic Integration Career Counselling Parenting Support Personal Growth Other If you listed several concerns above, please share up to 3 concerns that are your priority/the most distressing for you What currently makes you feel most like yourself? (ie. Other healing/personal growth activities, or hobbies) Do you know what type of support best fits what you're looking for at this time? Long term, depth focused counselling that gets to the root of the challenges you're facing Tools based / mindset / more solution-focused counselling or coaching that is likely to be more short term Still exploring / open to seeing what might be a fit for me Anything else you would like to share about yourself or what you're looking for in a counsellor? ie. are you looking for a counsellor who is: directive, more client-led, compassionate, gentle or who has certain values, or works in a certain way? Please share if there a counsellor or counsellors you were hoping to connect with: Don't worry, we will still offer you options that are a good fit for what you've shared! No preference Amanda Claire Yuan Utku Cassidy Donna (Online Only) Hannah (Online Only) Tori (Online Only) Esther (intern) Tanya (intern) Mercedes (Waitlist) Saffron (Waitlist) Camille (Full) Courtney (Full) Morgan (Full) How did you find New Tides Google Ad Google Psychology Today BCACC Listing Lumino / Sunlife Referred by Dance Community Referred by a friend or family member (not a client) Referred by a friend or family member (currently a client) Referred by Another Professional (please let us now below!) Other (please specify below) How would you prefer to be contacted Email Phone Either Thank You! One of our counsellors or our admin team will be in touch ASAP * Please check below to indicate that you understand that no form of electronic communication can be guaranteed as completely secure, that you consent to be contacted via email, and that you agree with our privacy policy: www.newtides.ca/privacy-policy. If you do not hear receive a response within 24 business hours, please check your spam folder. I Agree Thank you!
