Contact Community Counselling Centre Inc., Edmonton

Call Us today!

#202, 10534 – 124 Street
Edmonton, Alberta, T5N 1S1
Telephone: (780) 482-3711
Fax: (780) 488-9407

To contact us, please choose one of the forms below:

Your Name*
First Last
Your Email*
Primary phone number*
Alternate phone number
Address*
City Postal Code
Your preferred form of contact:*
- Phone
- Email
First and last name of any other people who will be attending counselling. If any are under 18 years old, please list their age.
First Name Last Name Age (if under 18)
What is your preferred appointment time?
Monday
- Mornings
- Afternoons
- Evenings
Tuesday
- Mornings
- Afternoons
- Evenings
Wednesday
- Mornings
- Afternoons
- Evenings
Thursday
- Mornings
- Afternoons
- Evenings
Friday
- Mornings
- Afternoons
- Evenings
Saturday
- Mornings
- Afternoons
Type
- Individual
- Couple
- Family
- Premarital Counselling
Your gender or identity:*
Preferred gender of counsellor:*
Your presenting concern:*
Your gross annual family income and number of dependents so that we can quote a session fee:*
If you want to utilize a benefit plan, please give us details including the required counsellor credentials.
How did you hear about us?*
The confidentiality of your private information is protected by an SSL Security Certificate. We will normally respond same business day to your request for counselling. Thank you for contacting us.

First Name	Last Name	Age (if under 18)