DBT Intake – STG Health Intake

Pre-registration DBT Registration Form A

First Name

Last Name

Your Best Email

Your Best Phone Number

Address

Your Address

City

Province

Postal Code

Which service are you wanting to pre-register for?

Self-declaring as Canadian Indigenous person?

Please enter your Treaty Card Number

Enter your Birthday (YYYY/MM/DD)

When did you complete the standard DBT Skills Training?

Are you currently seeing a mental health professional for individual counselling?

Brief Reason why you are seeking services

Signing this form indicates your voluntary pre-registration for the DBT (advanced) Skills Training or individual counselling without committing to a registration contract. You acknowledge that pre-registration does not replace any ongoing professional mental health support, nor does it address situations or behaviours that require an immediate response. Your participation in any services releases STG Health Services Inc. and the therapists and facilitators from liability.

When you agree to the above conditions, please enter your name below to complete your registration.