Booking Form

For counselling inquiries, please complete the form below and you will receive a response within 24 hours.

Please be assured that all information sent to Couples On The Road is kept confidentially. Your details will only be kept if you become an actual client. Your privacy will be protected to the full extent of the law and professional ethics.

First Name(required)

Last Name(required)

Email(required)

Phone(required)

Do you currently reside in BC?(required)

Yes No

What are you interested in booking?(required)

15-Min Free Phone Consultation Premarital Education Package (3 sessions) Premarital Education Package (6 sessions) Couples Counselling Session Individual Counselling Session

Days and time preferred(required)

Do you prefer to meet in person or online? *Not applicable for 15-min phone consultation (required)

Online In person

Reasons for counselling:(required)

Booking Form

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