2022 Child Counselling Online Intake & Pre Survey with Screening

Step 2 - 2022 Family Counselling - Children Intakes & Pre Surveys with COVID-19 Screening

  • For parent and/or parents that have completed the Parent(s) Only session. Prior to child(ren) 6-15 years of age attending a Parent/Child session please complete the following form. Thank you
  • MM slash DD slash YYYY
  • If Parent(s) have completed a Parent Only session please indicate the therapist name for that session Otherwise indicate if you have a preference or been referred to a specific therapist at FSCA.
  • FSCA Client information regarding COVID-19
  • MM slash DD slash YYYY
  • Office Use Only
    Please choose all that apply.
  • Physical or Emotional IntimacyPersonal StressAlcohol / DrugWork / School StressMarital Separation / DivorceOther relationshipsParentingGriefHealth / Mental HealthSuicideIntimate Partner Violence (child abuse, senior abuse, ect, past or present)AssaultTraumaJob LossOther
    1 being the most important...4 being the lesser important
    The session day/time clients choose may not be the Actual booking day/time.

Contact Details

Main Office:

Family Services of Central Alberta

5409 - 50th Avenue

Red Deer, Alberta

T4N 4B7

Office Hours

Main Office:
8:30am – 4:30pm

Extended hours on Monday/Tuesday:
5:15pm – 8:00pm

Toll Free: 1-866-414-3722

Email us: fsca(at)fsca.ca

Park Plaza Intergenerational Centre

5214 - 47 Avenue, Red Deer

Visit by appointment only Phone: 403-967-0171

Parkland Mall Kinsmen Family Play Space

Hours of Operation:
Monday - Friday
9:30am – 3:00pm

Parkland Mall:  4747 - 67th Street, Red Deer

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