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Intake Form

Intake Form

The Canadian Mental Health Association provides mental health promotion and mental illness recovery-focused programs and services for people of all ages and their families.

At CMHA VERNON, we offer a variety of programs and services to individuals overcoming mental health issues. Fill out an intake form and join CMHA today!  There are three convenient ways to obtain an intake form:

  1. Pick one up at our office at 3100 – 28th Ave, Vernon, BC.
  2. Fill out the form at the bottom of this section.
  3. Print out our printable intake form and fax or mail to CMHA VERNON.
Name(Required)
Do we have permission to leave a voicemail on the phone number provided?(Required)
Do we have permission to text the cell number provided?(Required)
Are you connected to Mental Health Services?(Required)
Consent
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