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Book Intake
STG Health Services Inc.
STG Health Intake Request
Use the form below to book your intake.
Intake Form
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Your First Name
Your Last Name
Your Best Phone Number
Your Best Email
Are you a Canadian Indigenous Person?
- Select -
No
Yes, Status
Yes MN-S Citizen
Were you Referred to us?
- Select -
No
Yes, by a friend or relative
Yes, by my Doctor / Nurse
Yes, by a Mental Health Professional
Doctor's / Nurse's Name
Mental Health Professional's Name
What are you Inquiring about?
- Select -
Adult Anxiety / Mood
ADHD Skills for Adults
Autism Supports for my child
Childhood Anxiety
Counselling for Newcomers (Immigrants)
DBT Skills Counselling (Borderline Personality)
Difficulties Sleeping (Insomnia)
Grief & Loss
Guided Self-Help
Learning Difficulties
Parenting Difficult Behaviours
Picky Eaters (child)
Psychological Assessment
Understanding your (child's) Neurodiversity
Something Else 🙂
When do you want to meet?
- Select -
As soon as Possible
Within a few Days
Within a Week
Within two Weeks
Please enter your Child's First Name
How old is your Child?
What would you like to discuss?
I agree to the following statements: submitting this form will forward my information to STG Health Services Inc. I understand that incomplete forms or inquiries irrelevant to counselling and requesting an intake appointment will be discarded. All marketing and spam submissions will be deleted.Â
I understand I will receive a text message and an email about making an intake appointment.
I understand submitting this form does not provide crisis management or urgent mental health support. If I need help now, I will call the Health Line 811 immediately or contact 911.
Request Intake
