Support Person Context and Insight Form Form

This form allows you to share your honest concerns about the person receiving counselling. Your feedback helps their counsellor provide the most effective support possible.

We understand sharing difficult observations can be challenging, especially when it involves someone important to you. Please be candid—your perspective is valuable and will be handled with care.

Confidentiality option: At the end of each response, you may indicate any information you do not want explicitly shared with the person in counselling. Your counsellor will address these concerns discreetly without revealing you as the source.

Our goal is to support them effectively while also providing you a safe space to be heard.

To complete: Click in each field and type your response to these question(s). Text boxes expand as needed. Move to the next question when ready. Thank you for taking the time to help.

I affirm this information is truthful and accurate to the best of my knowledge.

Thanks for submitting!

Thank you for trusting us with their care.