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Affirming Therapy Pilot Intake Form
To register, please take the time to fill out the information below.
First name
Last name
Email
Birthday
I am applying for:
Please provide a brief description of your presenting concerns. * This will help us match you with a therapist and ensure we are best serving you.
I currently reside in the Shuswap region and am part of the LGBTQ2SIA+ Community.
*
Yes
No
What are your promouns?
Submit
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