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Intake Form 

All the services provided are based on peer-to-peer support model. We do not provide counselling, crisis support or therapy. We offer individual grief support sessions and various grief healing peer support groups. 

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If you are seeking Clinical Counselling Support, please call York Region Support Services: 905-898-6455. If you require immediate services, please call COPE: 1-855-310-2673 or 911. 

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Children and Youth under the age of 16 will require a parent or guardian to call the office to start the intake process and provide signed consent form (provided). 

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The questions regarding your identity is used for statistical purposes for our funders and to identify service gaps in our community.  We remain committed to ensuring a fully inclusive, safe space for all members of our community.   

Please complete the form below to have your initial 1:1 support session scheduled. A member of our Grief Healing Support Team will contact you within 3 business days to schedule your 1:1 session. 

Grief Healing Support Centre 
Bereaved Families of Ontario - York Region
Intake Form
What Type of Support(s) Are You Looking For?
What Is Your Gender?
What Is Your Race/Ethnic Identity?
What Is/Are Your Preferred Spoken Language(s)? Check all that apply
Barriers to Support , You Would Like Us To Be Aware Of?
Are You On ODSP (Ontario Disability Support Program) or E.I. (Employment Insurance)?

Thank you for completing the Intake Process. We will get back to you in 2 business days.

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