New Client Intake
For new individual, couples or family counselling clients. This form collects contact information, reasons for seeking therapy, consent, billing and insurance information.
Complete one form for each individual client.Client forms
Complete your forms before your appointment.
Confidential · Secure · Online
Before your appointment
Choose the form that applies to you.
Completing the appropriate form in advance helps your therapist prepare for your first appointment. Please use the forms below unless the clinic or your therapist has given you different instructions.
Consent for Treatment of a Child
For counselling involving a client under age 18. The form covers consent, confidentiality, custody information, parent or guardian contact information and insurance details.
Must be completed individually by both parents or by the sole legal guardian.
Confidential & secure
The forms open in Luciak Counselling’s secure online form system. Complete only the form requested for you or your child, and contact the clinic if you are unsure which form applies.
Need help?
Questions about your forms?
If you are unsure what to complete, have questions about consent, or need assistance before your appointment, contact the clinic.
Contact the clinicLocal counselling in Red Deer
Luciak Counselling — Red Deer
Counselling and therapy for individuals, couples, children and families.
Contact the clinic