Trauma and Depression


Is it okay to leave a phone message?
 Yes    No

How do you identify your cultural background?
This information will increase our awareness of specific cultural concerns and practices, and help us identify who we are reaching with this program.

 African Nova Scotian
 New immigrant

How did you hear about this program?
 Community Health Team
 Family Doctor
 Mental Health Professional
 Family Member
 Community Organization

Do you consent to being contacted within the next 12 months for a follow up evaluation?
 Yes    No

Are you registering as an individual or a supporting family member?
 Individual    Supporting Family Member

What is your preferred language?
 English    French

If you dont know your zone please refer to the link below.
Please Click Here