ICBC Request an Appointment

Please complete this form with your ICBC CLAIM# so we can book you in immediately.

Don’t have an ICBC CLAIM# call us now and we’ll explain how to get one.


    Is this for Counselling? - click on box Yes

    Is this for Neurofeedback? - click on box Yes

    First Name*

    Last Name*



    Date of Birth - to find you the best counsellor fit*

    Date of Accident*

    Claim Number - (No Claim # call us on how to get one - 604-732-3930)*

    Are you attending Counselling at another Clinic? YES/NO*

    Adjuster Name

    Lawyer Name

    Doctor letter? YES/NO

    Brief Description of Symptoms Resulting from the accident

    Are you currently missing work/school? YES/NO