Walk-in (Call-in) Counselling Clinic Screener

Introduction


Please Note:
Our Walk-in Clinic has now been changed to a “Call-in Clinic” in order to help control the spread of Covid-19.

Our Walk-in Call-in counselling service will offer you a single telephone session appointment to meet with a counsellor to talk about your concern(s). We will explore different ideas to help you with whatever has brought you here today. Our approach focuses on solutions and the strengths you and/or your family possess. We know that a single session has helped many individuals and families and we hope that you have a similar experience.

Our Call-in (Walk-in) Clinic hours are Tuesday and Thursday afternoons from 1pm to 7pm. if you are in crisis outside of these hours, please call the crisis line at: 705-495-8198 or 1-800-352-1141.

What to expect from your visit today:

  1. You will be asked to answer some questions with the counsellor before your session begins.
  2. CCCNIP does not provide court letters or reports for clients of the Call-in Clinic.
  3. Everything you share is confidential.

The only exceptions are the following:

  • If your file is subpoenaed by a court of law
  • If a child or youth age 18 or under is being abused
  • If you are at risk of harming yourself or someone else
  • If you disclose that a person with a developmental disability is being abused or neglected

I/We understand and consent to the above counselling and service conditions.

Demographic Information

YesNo

YesNo

Addictions (alcohol, drugs, gambling)Intimate partner or family violenceSexual assaultDevelopmental disabilitiesFinancial problemsWork or interpersonal conflictRisk to self or other

Risk Assessment Summary

Has the following has affected your reason for being here

PhysicalSexualVerbal/Emotional

BullyingHarassmentAssaultVerbal/Emotional

AlcoholDrugsGambling

Suicidal Ideation: I have thoughts of killing myself.Plan: I have made a plan to kill myself.Access/Means: I can carry out my plan any time.