Help us match you to the right specialist
Your contact details so we can reach you and book your first appointment.
Basic Information
First Name *
Last Name *
Phone *
Please enter a valid phone number (digits only, minimum 10).
Email *
Please enter a valid email address (e.g. [email protected]).
How did you hear about us? *
Please select how you heard about us.
Have you received services from VPC before?
Previous counselling services elsewhere?
Preferred Associate
Welcome to Vancouver Psychology Centre
We'll match you with the right specialist. What type of support are you looking for?
Which service are you looking for?
Adult Therapy / Counselling
Help us understand what you'd like to work on. Select all that apply.
What condition best describes your concern?
Treatment & Preferences
Previously treated for this concern?
Appointment preference *
Additional Notes
Child & Youth Therapy
Name of Child *
Age of Child *
Are you their legal guardian? *
Relationship to child
Guardian relationship status
What condition best describes the concern?
Previously treated for this concern?
Appointment preference *
Additional Notes
Couples Counselling
Please provide details about your spouse / partner.
Partner's First Name
Partner's Last Name
Partner's Phone
Partner's Email
Partner's Date of Birth
Previously seen a couples counsellor?
Appointment preference *
Additional Notes
Divorce / Separation — Co-parenting
Collaborative process. Please provide details about your spouse / partner.
Partner's First Name
Partner's Last Name
Partner's Phone
Partner's Email
Partner's Date of Birth
Lawyers involved?
Lawyer Name
Court involvement?
Previously seen a practitioner for this?
Appointment preference *
Additional Notes
Divorce / Separation — child/youth
Collaborative support for your family. Please provide details about your spouse / partner.
Partner's First Name
Partner's Last Name
Partner's Phone
Partner's Email
Number of children involved
Children's ages
Who are you seeking services for?
Previously seen a practitioner?
Lawyers involved?
Court involvement?
Lawyer Name
Parenting Coordinator involved?
Parenting schedule
Parenting Coordinator Name
Section 211 report scheduled?
Collaborative divorce process?
Looking for co-parenting counselling?
Appointment preference *
Additional Notes
Find your Coaching focus
Which category best aligns with your challenge?
Previously worked with a coach?
Insurance coverage for this service?
Appointment preference *
Additional Notes
Assessment Services
Which type of assessment are you looking for?
Unfortunately, VPC does not provide this type of assessment. We suggest you contact another clinic to source out this service.
Third party requesting this assessment?
Appointment preference *
Additional Notes
✓
Thank you.
We have received your information and one of our clinic staff will contact you shortly to answer any questions and book your appointment.