Intake Package – Family

Enter Information Below

Intake Package - Family
  • Introduction
  • Client Information Participant 1
  • Client Information Participant 2
  • Client Information Participant 3
  • Client Information Participant 4
    • 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 (only required for children under age 12)
    • Consent to File Management Form (only required for youth aged 12-17)
    • Family Counselling Agreement
    • 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!