You may complete and submit the following form online, or, download a copy and print and submit at your convenience:

Please Note: Our Background Information form can be filled online by selecting Option 1. below. If you prefer to complete the form manually, please download the form at option 2 below.

Your counsellor is usually assigned within 3 business days of receiving your form. If you have not received a call to set up your first appointment by this time, please email ( or call us at (403) 342-0339 to confirm your appointment status.

Option 1. Complete the online Background Information Form , or;

Option 2. Download the Shalom Background Information form (September 2017)  then drop off, mail, scan, email, or fax your completed form to (fax 403-314-1798). Our mailing address is

Shalom Counselling Centre
5515 27 Ave,
Red Deer, AB T4P 0E5


Parents of Minors, please download and return the Parental Consent Form 2017


Confidentiality and privacy are held to a high standard at Shalom Counselling Centre, however if you choose to complete and submit forms to us online, your privacy cannot be guaranteed for any communication taking place via the internet.

For more information about Shalom, call us at 403-342-0339 or email

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