Counselling Request Form

Exclusively for InnoviCares Members
Innovicares - Counselling Request Form - ENG

If you are experiencing a crisis situation or any other urgent matter, please contact the 24/7 Aspiria Clinical Response Centre at 1-877-234-5327 or go to the nearest hospital emergency room.

Returning Visitors

Because your information is on file, you don't need to fill out the form again.

Please tell us a little more about yourself:

Payment Information

The cost for a single counselling session is $120 plus HST. After you click "Submit Form" you will be directed to PayPal where you can pay via credit card or PayPal. A PayPal account is not required.

When done, click the "Return to ..." link on PayPal for next steps.

By clicking on this box, I am providing my expressed consent to receive electronic communications including emails about new services and promotions from HumanaCare. I understand I may withdraw my consent at any time by emailing HumanaCare.

Please fill out the form to the left (all fields required)