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Subsidy Intake: $35 per session to see an intern counsellor.
Use this form if you have an estimated annual gross income less than $30,000 or you cannot afford to pay the $65 rate.  Please note if you have extended health benefits, you will need to fill out the $65 or $140 forms. Subsidies are for individuals only, couples and family will need to fill out the $100 or $140 forms.
 

Personal Information

Contact Information

Is it ok to leave a message on this number? Required

General Information

What format of counselling would you prefer (check all that apply) Required
Choose the days and times that you are available for counselling. For in-person sessions, we suggest booking 6-12 appointments ahead with your counsellor, though its optional. Consistency in your appointment day and time is recommned due to limited room availability. You can modify appointments with 48 hour' notice if space is available, otherwise, a virtual session may be necessary.

A note about appointment times:  An option to reduce your waitlist time is to choose morning appointments (8am to 11am) Monday to Friday. By making this time available you will likely get in to see a counsellor sooner.

Presenting concerns, click all that apply:

Financial Information (If you have insurance coverage please fill out the $65 form.)

The subsidized rate is valid for up to 12 sessions. If you would like to extend your counselling, you must reapply.

Methods of Payment
For any online counselling (video or phone ) a credit card, visa/MC debit, will be required for payments. Your payment method must be set up in the Jane App system before your first appointment. All payments will then be processed at the end of each counselling session by your counsellor. We do not accept e-transfers. For in-person session, we also accept cash or interac.
 

Other

Our Disclaimer:
South Island Counselling is a non-profit organization attempting to alleviate the immense need for affordable mental health services. We will not tolerate any harassment, hostility, or any form of aggression or abuse towards any of the counsellors or staff at any time. If we feel a client or potential client has committed any of the above, we will not provide counselling services.

Our Mission

is to strengthen mental, emotional and spiritual health in our community by providing excellent, professional and affordable counselling and training.

Our Location

3821A Cedar Hill Cross Rd.

Victoria, BC V8P 2M6

Tel: 250-472-2851

Fax: 250-472-2815

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©2025 South Island Centre for Counselling and Training Society

 

We acknowledge with respect the beautiful and traditional territories of the Lekwungen People, who are now known as the Esquimalt and Songhees Nations.

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