Name *

First Name

Last Name

I would like to attend counselling sessions: *

in person

remotely on secure video chat

either way works for me

Do you know someone who is currently in counselling at Ciel? If yes, we will make sure you don't work with the same counsellor.

yes

no

not sure

You will receive a response to your inquiry in 1-2 days.

please email me to the address I provided above

I understand that the response to my inquiry could end up in my junk folder

I will check my junk/spam folder and reply back

Phone

If we can't reach you by email we will let you know by phone/text that your name has cleared the wait list.

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