Intake Package – Child

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Intake Package - Child Draft
  • Introduction
  • Client Information
  • Terms & Consent

Counselling & Psychological Services

217-1550 Kingston Rd. Pickering, ON L1V 1C3

302-222 King St. E., Bowmanville, ON L1C 1P9

Welcome to LifeCare Centres. We are so grateful that you have chosen our team to walk alongside you on your journey. We are here to assist you every step of the way as you get set up as a client. Whether you are signing up for therapy for yourself, your child, your family or with your spouse, we tailor each welcome package to ensure that we respect your privacy, confidentiality, and receive your consent.

We ask that you fill out and sign the attached forms. These forms provide us with some basic information about you and your family, while providing you with important information on consent, confidentiality, disclosure and fees. If you have questions at any point, our team is here to assist.


Below you will find a list of requirements we ask you to complete before you begin your first session.

  • Client Personal Information Form
  • Limits of Confidentiality Form
  • Parent/Guardian Consent Form
  • Virtual Session Agreement
  • Professional Counselling Agreement
  • Free 15 Minute Consultation


Thank you for taking the time to complete this process.



LifeCare Team



This form is designed to ensure the privacy and confidentiality of the information it contains and it will not be shared without your informed and written consent. All Lifecare team members are bound by professional and ethical standards to maintain strict confidentiality and to protect the privacy of our clients. Rest assured that any information provided in this form will be treated with the utmost discretion and respect for your privacy.


Local: 905-231-2273
Toll Free: 1-855-231-2273

Monday – Friday : 9am –  9pm
Saturdays: 9am-5pm
Additional hours by Appointment Only

Pickering Office

1550 Kingston Road
Suite 217,
Pickering, ON
L1V 1C3

Bowmanville Office

222 King Street East,
East Wing, Suite 302
Bowmanville, ONT
L1C 1P6

Book Your FREE 15 Minute Consultation

We invite you to contact us for a confidential and complimentary 15 minute consultation. We will assess your needs, understand your concerns, and match you with the right therapist.


For all other inquries, please contact us!