Intake Form

Intake Form Instructions

Click the link below to download the intake form. Then submit your form to me. There are 3 different ways to submit your intake form (I'm happy to snail mail it if you would rather.), PICK ONE of the options below:

1. Fill in the form using the free Acrobat reader on your computer, digitally sign it, and email it to me NOTE: YOU MUST DOWNLOAD the file to your computer in order to use the digital signature feature. This will not work in a web browser.

2. Fill in the form using mobile device or computer. Print and sign the last page, scan and send back to me via email.

3. Print entire form, fill it in, then scan and email it back to me. You can also snail mail it back to me at: Angela Poch, 3996 Galloway Frtg Rd Galloway BC V0B1T2. Be sure you allow 10 days from the time you mail it till your intake session appointment time (so receive the document before your session).

If you have any questions about how to fill out this form please feel free to email me.

Intake Form