Help begins here… If you’re covered through your employer, health benefits insurer or other organization to receive support from an Arete assistance program and are looking for counselling services or other guidance—you’ve come to the right place. Simply complete and submit this form and get the help you need. If you’re thinking about suicide or are worried about a loved one, please contact the Canada Suicide Prevention Service immediately at 1.833.456.4566 or text 45645. They’re available 24/7/365 to help. Tell Us About YourselfTell us a bit about yourself so we can make sure we get you connected to the support you need, as quickly as possible.Please be aware that all your information is kept confidential unless there is a risk to yourself, someone else or if subpoenaed by a court of law. What's your name?*Not looking for support for yourself? That's okay, you'll let us know who the services are for later. First Last Are you the covered user?*The covered user would be the person in your household who has access to Arete services through their employer or insurer. If it's you, click 'Yes'. If it's your spouse/partner/parent, click 'No'. Yes No What's the covered users name?* First Last What's your relationship to the covered user?* Spouse/Partner Child Are you looking for help for yourself or on behalf of someone else (a dependent child)?* Myself Dependent Child (please complete the rest of the form using their information) What's your child's name?*Don't forget to complete the rest of the fields on this form using your child's information (even if the question says 'you/your'). First Last What's your birthdate?*If you're completing this on behalf of your child, please enter their birthdate. DD slash MM slash YYYY What's your gender identity?We ask this for reporting purposes so that we can learn more and better serve you through our program and service offerings.FemaleMaleTransgenderGender NeutralNon-binaryAgenderPangenderGenderqueerTwo-spiritThird GenderOtherPrefer Not to SayWhat's your marital status?We ask this for reporting purposes so that we can learn more and better serve you through our program and service offerings.SingleCommon-law RelationshipMarriedDivorcedWidowNot ApplicablePrefer Not to SayOf the four options below, what best defines you?* Employee or Business Owner/Manager Retiree Post-secondary Student I'm a child - this doesn't apply to me Have you been referred specifically to Arete counselling by your manager?*If you referred yourself, just click 'No' and continue with the form. Yes No Please enter your referring manager’s name. What's the name of the organization or insurer you have coverage under?*Choose from the list the name of your (or your spouse's/partner/parent's) insurer/benefits organization/other provider that allows access to Arete services.Chambers of Commerce Group Insurance PlanJohnston GroupLewer CanadaPayworksTelus HealthWawanesa LifeWestern Financial Group Insurance Solutions (WFGIS)Other/None of the AboveDon’t KnowWhat's the name of the company or organization that you (or the covered user if that's not you) works for?We're looking for the name of the company that provides access to Arete services. This will help us make sure we know who you are and can get you the support you need as quickly as possible. What's your firm number?*This is the unique identifier that will help us make sure we've got the right person, connected to the right organization and can get you the support you need as quickly as possible. What's your group number?*This is the unique identifier that will help us make sure we've got the right person, connected to the right organization and can get you the support you need as quickly as possible. What's your policy number?*This is the unique identifier that will help us make sure we've got the right person, connected to the right organization and can get you the support you need as quickly as possible. What's your customer number?*This is the unique identifier that will help us make sure we've got the right person, connected to the right organization and can get you the support you need as quickly as possible. What's your division/firm/group/customer number?*This is the unique identifier that will help us make sure we've got the right person, connected to the right organization and can get you the support you need as quickly as possible. What's your certificate or user number?If you have access to Arete services through an insurance company, often they'll use a number that's specific to you. If you don't have it, you can leave this one blank. What's your preferred phone number?*What type of line is this?* Personal cell Home Work Work cell Can we text you? Yes No What's your preferred email address?* What's your home address?* Street Address Address Line 2 City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Tell Us About Your WorkWe ask the next few questions for reporting purposes so that we can learn more and better serve you through our program and service offerings.What's your current job title?* How long have you been with your current employer?* Of the options below, what best defines your current employment status?* I'm working full time I'm working part time I'm working casual I'm working contract I'm on a leave Choose the type of leave that best fits your current situation from the list below.*Maternity/parental leaveSick leaveShort term disabilityLong term disabilityIllness (employment insurance)Leave of absence (medical)Leave of absence (personal)Other/don't knowWhat was the last day you worked?* DD slash MM slash YYYY How Can We Help?Now we need to know more about the types of challenges you're facing so we can get you the help you need.What type of support are you looking for?*Because plan offerings can be slightly different from one another, it's possible that your plan may not give you access to all services listed below. Don't worry though, we'll be in touch if that's the case and will work with you to find the support you're looking for. Counselling support Nutritional guidance Eldercare guidance Personal legal guidance Personal financial guidance Childcare navigation support Are you having suicidal thoughts?*We ask this question so we can offer you the best therapeutic match. If yes, please tell us more in the question below. Yes No If you or a family member are in immediate risk, please contact the Canada Suicide Prevention Service immediately at 1.833.456.4566 or text 45645. They’re available 24/7/365 to help. If you also complete and submit this form, we’ll email you in 1-2 business days with the name and number of the counsellor we think will be the best fit for you based on the information you provide in the questions that follow. Tell us about the challenges you're facing.*The more detail the better so we can match you with the professional who we think will be the best fit for you.How would you prefer to connect with a counsellor? Check all that apply.*Please know that we always do our absolute best to accommodate preferences. In person By video By telephone What are your preferred appointment times? Check all that apply.*As we said above, we always do our best to accommodate preferences. Days Evenings (5 p.m. onward) Weekends No preference To help us match you to a counsellor who's a great fit for you, are there any other details you'd like us to consider?Sharing preferences like counsellor gender identity, lived experiences, spiritual background, geographic location, etc. goes a long way to helping us find you an excellent counsellor match. Can we leave you a message at your preferred phone number?*We'll only call you if we need to clarify details or gather more information to make sure we match you to the professional who's the best fit. Yes No What type of message can we leave? Detailed General Thank you for reaching out. Once you click submit, we'll email you in 1-2 business days with the name and number of the counsellor we think will be the best fit for you based on the information you provided (please keep an eye on your email/junk mail folder for an email with the subject: Counsellor info). It will then be up to you to reach out to them to book your first appointment at your convenience. If you find that the counsellor we've recommended isn't a good fit, please let us know right away so we can reassess and make it right. Tell us about the kind of nutritional guidance you're looking for.*The more detail the better so the professional we connect you with understands the challenges you're facing and is ready to help. Note that nutritional guidance is provided by phone only.Tell us about the issues you're having with eldercare.*The more detail the better so the professional we connect you with understands the challenges you're facing and is ready to help. Note that eldercare guidance is provided by phone only.Tell us about the reason you're looking for legal guidance.*The more detail you can provide the better, with a note that personal legal guidance is intended for general consultation only, so developing materials on your behalf or consulting on highly complex issues are not covered. Note that personal legal guidance is provided by phone only.Tell us about the reason you're looking for financial guidance.*The more detail you can provide the better, with a note that personal financial guidance is intended for general consultation only, so developing materials on your behalf or consulting on highly complex issues are not covered. Note that personal financial guidance is provided by phone only.A professional from the Arete Network will call you within 1-2 business days to help. Can they leave you a message at your preferred phone number?*Just a note that Arete staff may also be in touch if they need to clarify details or gather more information to make sure we match you to the professional who's the best fit. Yes No What type of message can they leave? Detailed General What are some call back date/time windows (including time zone) that work best for you?*Just a note that professionals are available to connect within standard business hours, Monday-Friday.Thank you for reaching out. Once you click submit, a professional in the Arete Network will be in touch by phone within 1-2 business days to get you the support you need. Tell us about the challenges you're facing finding childcare.*The more detail the better so we can provide you with solutions that are the best fit for you and your child.Thank you for reaching out. Once you click submit, we will email you in 1-2 business days with childcare options we think will be the best fit for you based on the information you shared (please keep an eye on your email/junk mail folder for an email with the subject: Childcare info). It will then be up to you to reach out to find out more about the options you think will work for you and your child.reCAPTCHA
