Carolyn Waddell, MDiv 
Registered Psychotherapist

Individual, Couple, Family Counselling

 

Request Services

The form below is for requesting specific counselling services and courses without needing to send payment through first.  Therefore it is useful if you are paying by another method other than through PayPal, or if you are using the "Donation" option to pay for your counselling, or if you want to set up a future time to meet with the counsellor but are not yet ready to make your payment.  Please use this form to communicate with the counsellor.

Request Services
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Please fill out the form below to request counselling services and self help courses. Remember to also fill out the "Registration for Counselling" form if you have not done so.
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*Name: 
*Email: 
*Address: 
Telephone: (required for phone counselling) 
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Please check the counselling option(s) that you are requesting.






 
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For "real time" chat, phone, face to face sessions and intensive retreats, please fill out the following information:
Available Date(s) 
Available Time(s) 
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Where to Meet
(For chat, give skype ID; For phone, give number; For "in person" sessions state which office, Kincardine or Kitchener)
Chat (skype) ID 
Telephone number to call (if different from above) 
Location Preferred
 
If more than one person will be attending, please list additional names here. 
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Self Help Course Requested


 
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*Payment Method


 
Please send your payment as soon as possible. When payment has been received, you will receive the services that you have requested. Thank you.
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*required field
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Please click submit to send this form. You will receive a response shortly. Thank you.
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If you have not received a reply from the counsellor within 72 hours of sending this form, please email info@gracecounselling.com.

 

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