Intake Form

IF YOUR INQUIRY IS AN EMERGENCY, PLEASE CALL 911, THE CRISIS LINE AT 1-888-353-2273 or your doctor.

We provide services to children, youth, adults and families dealing with their own or someone else's substance use problem.

To book an appointment, we require all new and returning clients (after three months) to complete a Client Intake Form.

Choose one of the two options below to access our intake form from this website.

EKASS Client Intake Form (print hard copy - PDF) 

Secure Online EKASS Client Intake Form

When you have completed the On-line EKASS Client Intake Form and you've pressed the SUBMIT button at the bottom of the page, our office will automatically receive your form.

Another option is to complete the intake at our office or we can fax or email the form to you to complete and return.

In all the options listed above, once we receive your completed EKASS Client Intake Form, a staff member from an office closest to you, will contact you within 2-3 business days to book a counselling appointment.

Following the current COVID-19 safety protocols, we offer counselling sessions in-person (with mask), by phone or virtual.

Should you have any questions please click on the CONTACT US located top right corner to call one of our offices near you.


This page is encrypted using SSL. Any information you enter is secure and accessed only by our EKASS staff. We will not share this information with any unauthorized parties.