Tell us what has been difficult and what you hope will change.
The secure form asks about your concerns, health and practical needs. A clinician uses this information to consider your safety, whether our service can help, appointment availability and any funding requirements.
Complete the form privately and accurately
Identify current symptoms, work impact and safety concerns
Submitting the form begins a clinician review. It does not guarantee acceptance, create a therapeutic relationship, commit you to treatment or replace emergency care.
✓ Information is reviewed securely
✓ Fit and next steps are clarified
✓ You decide whether to proceed after contact
✓ These are orientation points, not a diagnosis or individualized assessment result.
Private & confidential
Information is not shared without consent except where required by law
Secure video
Available across Saskatchewan
$170–$350
Four service options · 60-minute appointments
No physician referral
No physician referral required to request care
What the intake covers
What we ask about and why
The form is designed to reduce repetition while allowing your own description.
Clinical
What is happening
Symptoms, timeline, triggers, safety and effects on work and daily life.
Context
Health and care
Relevant diagnoses, medication, providers, prior treatment and medical considerations.
Practical
Practical arrangements
Location, availability, coverage, communication preferences and requested purpose.
Why the form is detailed
How your information helps us plan next steps
The intake asks more than a single burnout question because similar symptoms may require different responses.
01
Is there urgent risk?
Identify immediate safety concerns or needs that cannot wait for routine review.
02
Is this the right service?
Consider burnout, mood, anxiety, sleep, trauma, ADHD, medical factors and scope.
03
What is most difficult in daily life?
Understand changes in work, relationships, self-care and capacity.
04
What practical arrangements are needed?
Review location, availability, funding and whether another provider should be involved.
After submission
What the clinic does
Reviewing your information helps us prepare for a useful conversation about your needs.
Review
Assess fit and safety
The clinic reviews the information for scope, urgency, availability and any missing details.
Clarification
Request only what is needed
You may receive an administrative or clinical question before scheduling.
Next step
Recommend an appointment, assessment or another service
If our service is a suitable fit and an appointment is available, we will offer one. If another service would be more appropriate, we will explain why and discuss possible next steps.
Deciding what comes next
What you can expect
The process preserves your choice at each stage.
Step 1
Submit the secure form
Describe your experience in your own words and tell us the main question you would like help with.
Step 2
Receive the review outcome
The clinic confirms whether the service appears suitable and what is needed next.
Step 3
Decide whether to proceed
An invitation to schedule does not obligate you to begin treatment.
Intake questions
Before you submit
Is the intake confidential?
Information is handled through the clinic’s secure intake process and used for service review, care and required administration.
Does submission guarantee an appointment?
No. A clinician reviews scope, fit, safety, availability and funding requirements before recommending an appointment, assessment or another pathway.
What if I am in crisis?
Do not wait for an intake response. Call 911 for immediate danger, 8-1-1 for Saskatchewan health advice, or call/text 9-8-8 for suicide crisis support.
Can someone help me complete it?
You may obtain practical assistance, but the answers should reflect your own experience and consent.
Ready when you are
Begin when you have privacy and enough uninterrupted time. Completing intake does not commit you to ongoing treatment.
Submitting the form begins a review process; it does not obligate you to proceed or guarantee an appointment.