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2026 Counselling – Children (6-15yrs) Online Intake & Pre Survey

2026 Counselling - Children (6-15yrs) Online Intake & Pre Survey

"*" indicates required fields

Session Type
If Parent(s) have completed a Parent Only session please indicate the therapist name the parent(s) met with
The following is the Family Services of Central Alberta Counselling No Show policy:
If an appointment is missed with no prior communication, it is considered a No Show.
If a client No Shows and then contacts the office to rebook, the client will be referred to the No Show policy.
If a client No Shows more than one appointment, the counselling team meet to determine how best to support the client, which may involve referral to another service
 
Parent(s) have you completed an Adult/Parent Only Online Intake form
Parent(s) must meet with the therapist for a Parent(s) Only session - prior to booking a Parent/Child session.
Bio Parent*
Address
Other Bio Parent
Address
Childs Name (if age 6-15yrs) (16 yrs & older can complete an Adult Counselling Intake & Pre Survey)
Gender*

Child Relationship to Bio Parent
Child Relationship to Other Bio Parent
Address - (please note which parents address is applicable or if child's address is different than either bio parent)
Please note if child(ren) have different address than Parent that completed the Parent Only session.
May we contact you after your sessions have ended for post evaluations?
Type of Counselling - Child*
Family Status*
Do you identify as*
Were you born in Canada?*
If no, length of time in Canada
Office Use Only
How did you find out about our counselling program?*
Please choose applicable
Please choose all that apply to your child(rens) situation*
"I know some healthy strategies to manage stress"*
"I can resolve conflict peacefully"*
"I can identify people in my life who really care about me"*
Have you ever had previous counselling for this particular issue?
Parents - how will this child session fees be paid?*
For Parent/Child(ren) Session - Do you have a preference for appointment day or time?
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
Phone: 403-343-6400
Fax: 403-343-6407
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

FSCA Play Space

Hours of Operation:
Monday & Thursday
9:30am – 12:00pm & various program times. 

Parkland Mall:  4747 - 67th Street, Red Deer
Phone: 403-309-5653
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