Additional Information

Are there any accessibility needs that we should be aware of?*

Yes
No

Please describe*

Do you have insurance?*

Yes
No

Insurance provider*

Other insurance provider*

How much are you covered for?*

Which service provider are you covered for?*

Household income*

Number of dependants based on this income*

Based on the information you provided, you have been assessed at $X/hr. You will need to provide us with a Notice of Assessment, Letter from EIA or some other financial document to ensure this is the amount you will be paying. Please upload this document below or email it to intake@aulneau.com. Please note that this rate may change if the information you provide is different.

Due to our mission at Aulneau Renewal Centre, we offer therapy on a sliding scale. We charge between $5 and $110 per 50 minute session, depending on household income, and the number of people living on that income. Please note that, in order to accurately assess fees, we require proof of income. Please upload most recent Notice of Assessment or scanned .pdf copy of a pay stub. If you are unable to upload the information at this time, please submit proof of income to us within 2 weeks of submitting your referral form. If we have not received the required information within 2 weeks, your intake request will not be processed.

Please upload documents supporting your income above

e.g. Notice of Assessment, Letter from EIA or some other financial document

Drop files here or

Healthy Child Manitoba

Based on the information provided above, you may qualify for our Healthy Child Manitoba program. Please fill out the details below to see if you are eligible.

Have you been to Aulneau before?*

Yes
No

Are you a new client?*

Yes
No

Is the child under 18 years of age?*

Yes
No

Birthdate*

Does the child and/or family have any involvement with CFS?*

Yes
No

Is the child/family involved in any custody disputes?*

Yes
No

What income criteria would you follow under?*

How many people reside in your household?*

Terms of Service

Terms of service*

I acknowledge and confirm that I have read the Terms of Service.

Aulneau Renewal Centre is currently experiencing a 8-12 week waitlist. Our intake coordinator will be in touch with you as soon as a therapist is available to see you and set up your first appointment. In the meantime, please ensure that the financial information is submitted as this helps speed the process. If you would like to speed up the process, please submit your financial information to counselling@aulneau.com as soon as you can. This helps us process your request quicker and can help you see a therapist if one is available sooner. Please ensure that the client name is provided in the email with the financial information.

CAPTCHA

Register for Counselling

Step 1 of 3

Client Information

Guardianship

Additional Information

Healthy Child Manitoba

Terms of Service