Important Notes: After receiving your submission, a member of the organization will contact you within 3 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 Halton/Peel. 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.


Wait Times: our individual support sessions and group sessions are free thanks to the donations received from our community. Since 2020, our organization has experienced fewer staff members and has seen an increased demand of 470% for our individual support sessions. These sessions are facilitated by 1 of 2 staff members or by a volunteer or student. Clients can expect an 8-12+ week waiting period between each individual support session due to these demands. We deeply appreciate your patience and understanding as we continue to navigate this. Should you require immediate support, please click here for a list of crisis and immediate phone support lines. For those wanting to attend our Peer Support Groups Only, please visit our FAQ for more information. The initial, Group Information Session may happen sooner than 8-12+ weeks as no sequential one-on-one sessions are provided.

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. 

Ensure to also check your Junk/Spam folders for a response as our initial emails are often sent there.