Interim Report

If you are a counsellor and interested in joining our network, please apply below.

In addition, we are currently accepting applications for:

Account Managers

Business Development Managers

Sales Professionals

Nurse Case Managers

Support Staff

If you stand out, tell us how you are the best:

Interim Report

File Number *

Member First Name *

Member Last Name *

Employer *

Presenting Problem *

Date *

Critical Screens

Yes

Self-Harm / Suicide

Harm to Others

Domestic Violence (If Yes describe) *

Interventions *

Solution Planning / Treatment Goal *

Community Resources Referrals *

Anticipated Number of Additional Sessions *

Counsellor First Name *

Counsellor Last Name *

Phone *

Email *

Consent *

Yes

I understand 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.

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