Confidential Intake & Referral

Request culturally informed counselling, a healing circle or a workshop — for yourself or someone you support. Share only what you are comfortable sharing.

This form is not for emergencies. If you or someone else is in immediate danger, call 911. For mental health crisis support in BC, call or text 9-8-8 any time.

Who is filling out this form?

About you

Name (or the name you'd like us to use) *

City

Phone

Age group

Which best describes them?

Best way to reach them *

It's safe to leave a voicemail or message

Support requested *

Culturally informed counsellingHealing & wellness circlesMental health workshopsNot sure — help me choose

Culture, language & needs

Preferred language(s)

Cultural, faith or identity preferences (optional)

What would you like support with? (optional)

Accessibility needs (optional)

I agree that Bridge Generations Society may store this information securely and contact me about support.