Download our client contract forms and return them below before your appointment.
If you are a teen or adult, please review and fill out the following:
1. Heart Times Service Contract
2. Heart Times Intake Assessment
3. Heart Times Video Counselling Consent
You may also benefit from looking at the Doxy.me Patient instructions if you have never used this video service before.
If you are a parent of a child, please review and fill out the following:
1. Heart Times Service Contract
2. Heart Times Parent Questionnaire - Developmental History
3. Heart Times Video Counselling Consent
You and your child may also benefit from looking at the Doxy.me Patient instructions if you have never used this video service before.
Heart Times Service Contract 2023 (Shelaine Grant) (pdf)
DownloadHeart Times Video Counselling Consent (pdf)
DownloadHEART TIMES - Intake Assessment (pdf)
DownloadHeat Times - Parent Questionnaire - Developmental History 2023 (pdf)
DownloadAuthorization to Relase Information (pdf)
DownloadDoxy.me Patient Instructions (pdf)
DownloadI acknowledge that I am an uninvited guest on the traditional, ancestral, and unceded territory of the lək̓ʷəŋən Peoples, known as Esquimalt and Songhees Nations, and Pacheedaht, Scia’new, T’Sou-ke, and W̱SÁNEĆ (Pauquachin, Malahat, Tsartlip, Tsawout, Tseycum) Nations. I acknowledge the forced removal and genocide of the Indigenous people of this territory. I recognize ongoing colonialism, racism, and structural violence against Indigenous people. This land acknowledgement is intended to communicate my continual efforts to actively reflect, recognize, reconcile, and partner with these Nations whose lands and water we benefit from today. I am grateful for the traditional Knowledge Keepers and Elders who are still with us today, and for those who have gone before us. I make this acknowledgement as an act of reconciliation and gratitude to those whose territory I have the privilege to live, work, and play.
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