• At this time Only Web sessions: Zoom or FaceTime OR Phone Sessions
  • Date Format: MM slash DD slash YYYY
  • FSCA Online Counseling Intake is designed that 4 members in a family can each complete a Single Session Therapy and Pre Survey Form. IF you are an Individual - complete Client 1 Only IF you are a Couple - complete Client 1 and Client 2 Only Thank you
  • Upon arrival to counselling session or at beginning of counselling session please have client(s) sign & date in this box area. Also, please note Therapist Name here...if not already noted. Thank you
  • Please complete Client 1 - Part 1 and Part 2 if this is an Intake for Individual, Couple or Family Counselling. Please complete all questions as noted by the * this information assists our agency program funders. Thank you.
    For Counselling Session Fee: please choose best applicable option. This can further be discussed during Intake review process and/or with the therapist.
    Until In-Person sessions are safe to resume - please choose an applicable option, thank you
  • Date Format: MM slash DD slash YYYY
  • Home Phone Number if No Cell Number Available
    FSCA Therapists do not get involved in legal issues - they may make referrals for this to other agencies.
    FSCA Therapists do not have a contract to work with this agency and may be able to make a referral.
    We apologize that we are unable to text to Android cell phones at this time. We will update this option if/when this becomes available. Thank you
  • Choose from drop down list to indicate your relationship to Client #2.
  • Choose from drop down list to indicate your relationship to Client #2.
  • Please answer the following Pre Survey questions as they assist agency program funders, thank you. Please complete if this is an Intake for Individual, Couple or Family Counselling. Thank you.
    This is for short term immediate intervention counselling.
  • Personal StressAlcohol / DrugWork / School StressMarital Separation / DivorceOther relationshipsParentingGriefHealth / Mental HealthSuicideIntimate Partner Violence (child abuse, senior abuse, ect, past or present)AssaultTraumaJob LossIntimacyOther
    1 being the most important...4 being the lesser important
  • Please complete Client 2 - Part 1 and Part 2 if this is an Intake for Couple or Family Counselling. Please complete all questions as this information assists our agency program funders. Thank you.
    For Counselling Session Fee: please choose best applicable option. This can further be discussed during Intake review process and/or with the therapist.
    Until In-Person sessions are safe to resume - please choose an applicable option, thank you
  • Date Format: MM slash DD slash YYYY
    FSCA Therapists do not get involved in legal issues - they may make referrals for this to other agencies.
    FSCA Therapists do not have a contract to work with this agency and may be able to make a referral.
    We apologize that we are unable to text to Android cell phones at this time. We will update this option if/when this becomes available. Thank you
  • Choose from drop down list to indicate your relationship to Client #1.
  • Choose from drop down list to indicate your relationship to Client #1.
  • Choose from drop down list to indicate your relationship to Client #1.
  • Please complete Client 2 - Part 2 if this is an Intake for Couple or Family Counselling. Please complete all questions as this information assists our agency program funders. Thank you. Please answer all of the following Pre Survey questions as this information assists our agency program funders, thank you.
    This is for short term immediate intervention counselling.
  • Personal StressAlcohol / DrugWork / School StressMarital Separation / DivorceOther relationshipsParentingGriefHealth / Mental HealthSuicideIntimate Partner Violence (child abuse, senior abuse, ect, past or present)AssaultTraumaJob LossIntimacyOther
    1 being the most important...4 being the lesser important
  • Please complete Client 3 - Part 1 if you are completing this Intake for Family Counselling: Child, Tween, Teen, Young Adult. Please complete all the questions as this information assists our agency program funders, thank you.
  • Date Format: MM slash DD slash YYYY
    We apologize that we are unable to text to Android cell phones at this time. We will update this option if/when this becomes available. Thank you
  • Choose from drop down list to indicate your relationship to Client #1.
  • Choose from drop down list to indicate your relationship to Client #1.
  • Please complete Client 3 - Part 2 if you are completing this Intake for Family Counselling: Child, Tween, Teen, Young Adult. Please complete all the questions as this information assists our agency program funders, thank you.
    This is for short term immediate intervention counselling.
  • Personal StressAlcohol / DrugWork / School StressMarital Separation / DivorceOther relationshipsParentingGriefHealth / Mental HealthSuicideIntimate Partner Violence (child abuse, senior abuse, ect, past or present)AssaultTraumaJob LossIntimacyOther
    1 being the most important...4 being the lesser important
  • Please complete Client 4 - Part 1 if you are completing this Intake for Family Counselling: Child, Tween, Teen, Young Adult. Please complete all the questions as this information assists our agency program funders, thank you.
  • Date Format: MM slash DD slash YYYY
    We apologize that we are unable to text to Android cell phones at this time. We will update this option if/when this becomes available. Thank you
  • Choose from drop down list to indicate your relationship to Client #1.
  • Choose from drop down list to indicate your relationship to Client #1.
  • Choose from drop down list to indicate your relationship to Client #1.
  • Please complete Client 4 - Part 2 if you are completing this Intake for Family Counselling: Child, Tween, Teen, Young Adult. Please complete all the questions as this information assists our agency program funders, thank you.
    This is for short term immediate intervention counselling.
  • Personal StressAlcohol / DrugWork / School StressMarital Separation / DivorceOther relationshipsParentingGriefHealth / Mental HealthSuicideIntimate Partner Violence (child abuse, senior abuse, ect, past or present)AssaultTraumaJob LossIntimacyOther
    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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