• Date Format: MM slash DD slash YYYY
  • Depending whether your counselling is: Individual, Couple or Family - please note the directions on how to complete the Online Intake below.
  • 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
  • Choose from drop down list to indicate your relationship to Client #2.
  • Date Format: MM slash DD slash YYYY
  • Choose from drop down list to indicate your relationship to Client #1.
  • Date Format: MM slash DD slash YYYY
  • Choose from drop down list to indicate your relationship to Client #1.
  • Date Format: MM slash DD slash YYYY
  • Choose from drop down list to indicate your relationship to Client #1.
  • 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.
    For Counselling Session Fee: please choose best applicable option. This can further be discussed during Intake review process and/or with the therapist.
  • Please answer the following Pre Survey questions, 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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