Book Intake

Intake Form

Your First Name

Your Last Name

Your Best Phone Number

Your Best Email

Your Province

Were you Referred to us?

Are you NIHB Eligible?

What are you Inquiring about?

When do you want to meet?

What would you like to discuss?

I agree to the following statements: by submitting this form, my information will be forwarded to STG Health Services Inc. (La Ronge Branch). I understand that incomplete forms or inquiries not relevant to counselling and requesting an intake appointment will be discarded. All marketing and spam submissions will be deleted.
I understand that submitting this form does not provide crisis management or urgent mental health support. If I need help now, I will call the Health Line 811 immediately or contact 911.