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Important Notes: After receiving your submission, a member of the organization will contact you within 5 business days to schedule your initial session with 1 of 2 staff or a volunteer or student (*If this is an emergency, please call 911 or visit your nearest emergency department). Please ensure you check your Junk and Spam folders as our initial email often is sent there. Our catchment areas are Ontario, specifically Halton/Peel regions. Please visit our FAQ for more information if you do not reside in Halton/Peel prior to completing this form. 

 

We do not provide counselling, therapy, or crisis support. All services provided are based on peer support. Visit our FAQ page to learn the difference between peer support and clinical support. Please refer to PsychologyToday should you like to receive counselling or therapy or click here for crisis/immediate support resources. 

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Children and Youth: If you are completing the form below for a child/youth below the age of 16, please complete the form as if they are (their name and birthdate, their relationship to the deceased, etc.). In the "Parent/Guardian/Caregiver Information" section, please include your Name and Role/Relationship, as well as your Contact Information if it differs from the child/youths. 

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Wondering if peer support is the right fit for you? CLICK HERE to complete a quick self-assessment!