Request for Services

Please be advised that as of April 6, 2022, Ruah Counselling Centre Inc. will be accepting new requests for services.

Client Name(Required)
MM slash DD slash YYYY
Address(Required)
May we email you?(Required)
Please note that email correspondence is not considered to be a confidential medium of communication.
Leave Message?(Required)

Source of Request

Name
If not self-request, is the client in agreement with the request?
Service Requested:(Required)
PLEASE NOTE:
Ruah staff member will be in contact with you within five (5) business days for appropriate follow up.
Ruah is not a crisis centre. If you require help immediately, please phone the Mental Health Crisis Line at: 1-888-737-4668 or go to your nearest Emergency Department.
This field is for validation purposes and should be left unchanged.