Background Information Form

Welcome to Shalom Counselling Centre of Alberta. Please complete the following Background Information Form to the best of your ability. You are not required to answer all of the questions; however, the more you do the better we are able to help you. Each person involved in counselling is asked to fill out a form individually so we can hear each point of view. All information collected is strictly confidential and will only be shared with the Shalom Team as needed.

Shalom Counselling Centre: 5515 27 Avenue, Red Deer, AB T4P 0E5 ǀ Phone: 403-342-0339 ǀ Fax: 403-314-1798 ǀ Email: