Intake Form

IF YOUR INQUIRY IS AN EMERGENCY, PLEASE CALL 911, YOUR FAMILY DOCTOR OR THE CRISIS LINE AT 1-800-353-2273.

We provide services to individuals or groups dealing with their own or someone else's addiction or substance misuse. To assist with your first appointment with a counsellor, we require all new and returning clients (after three months) to complete a EKASS Client Intake Form. At your request, we can fax or email the form to you to complete and return OR you may choose one of the two options below to access our intake form. The first link will download a version of the form (PDF) to print, manually complete and submit in person, by fax, by mail, or email to one of our offices closest to you OR select the second link to access a secure on-line 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.

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 three business days to book a counselling appointment. Following the current COVID-19 safety protocols, in person counselling sessions will be limited. As an alternative we offer phone or virtual sessions as well. Should you have any questions please click on the CONTACT US located top right corner of this page to call one of our offices near you. We'll be happy to assist you.

EKASS Client Intake Form (print hard copy - PDF) 

Secure Online EKASS Client Intake Form

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.