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Start your path to well-being by completing our Therapy Intake Forms. These forms allow us to gather information to ensure our services will meet your mental health needs. Therapy Intake Form I'm seeking services for: Myself (Please note that our clinicians only work with individuals under 30 unless you are seeking parenting support). My child Client's first name Parent's first name if client is a minor (under 18) Client's age Gender Phone number Email City of residence How did you hear about us? Service provider (e.g., pediatrician, general practitioner, psychologist, counsellor) BC Psychological Association Google or another search engine Family/Friend Other (please specify) Do you have extended health benefits coverage? Yes No Unsure Do you have coverage from any specific funding? Yes, from FNHA Yes, from Autism Funding Other (please specify) No What type of therapy service are you looking for? In person Virtual Either virtual or in person Do you have a preference for a specific clinician? Dr. Juliana Negreiros (R. Psych.) Dr. Kevin Noble (R. Psych.) Kelly Archer (RCC) Doctoral student or therapist working under either Dr. Juliana or Dr. Noble's supervision No preference. I will see whoever is accepting new clients so I can book an appointment sooner Reasons for seeking therapy services What problems have been concerning you? Please provide a brief description if applicable. Symptoms of anxiety (e.g., excessive worries about little things, perfectionism, social anxiety, phobias, physical complaints) Symptoms of obsessive-compulsive disorder [OCD] (e.g., intrusive thoughts/images/urgers, mental or physical compulsions, avoidant behaviour) Symptoms of body-focused repetitive behaviours [BFRB] (e.g.,hair pulling, skin picking, nail biting) Symptoms of ADHD (e.g., regulating attention, impulsive/hyperactive behaviour) Difficulty with peer interactions (e.g., friendships, bullying) Difficulty with family relationships (e.g., parent-child, sibling) Parenting challenges (e.g., setting consistent boundaries for their child, frequent conflicts, power struggles) Trouble at school/college/work (e.g., falling behind in schoolwork, getting into trouble with teachers, having conflicts with coworkers) Mood is low (e.g., irritable, low energy, sad, isolates self, feels hopeless) Impulsive or non-compliant behaviour (e.g., acting without thinking, refusing to follow rules or instructions, not obeying authority figures) Often breaking the rules or getting in trouble (e.g., skipping school or getting into fights) Risky or dangerous behaviours (e.g. self-harm, talking about suicide, threatening others with violence) Trauma (e.g., physical or sexual abuse, witnessing violence, or being involved in a serious accident) May be abusing substances (e.g., tobacco, alcohol, drugs) Body image or eating challenges (e.g., being overly concerned about weight or appearance, constantly dieting) Symptoms related to autism (e.g., difficulty with social communication, rigid behaviour, need for predictability, sensory sensitivities) Gender identity questions (e.g., having uncertainties or concerns about one's gender identity) Have there been any recent stressors that could be contributing to the client's difficulties? Please indicate below: Have your child (or you if the client) ever: Endorsed suicidal thoughts? Engaged in self-harming behaviour? Been taken to the ER or been hospitalized due to mental health concerns? None of the above Is there any other information that you would like to share that may help us better support the client? Please indicate below: Submit Thanks for submitting! Thank you for completing this form. We will review your information and contact you as soon as possible. Please note that due to the high demand for services, there may be a delay in our response. Service availability depends on clinician availability and client needs. Should you have any questions in the meantime, please don’t hesitate to contact us at contact@beaconpsychology.ca . Warm regards, Beacon Psychology Team Want to know how we protect your data? Click here to learn more.

Anxiety resources to help children, teens, families, and educators learn about anxiety, understand CBT and more! Anxiety Resources Free Interventions Confident Parents: Thriving Kids – Anxiety : A free coach-based program offered by the Canadian Mental Health Association in BC to help parents support their children aged 3-12 to manage anxiety. Mind Space Virtual and In-Person Psychoeducational Groups : A variety of programs for individuals aged 17.5 + with anxiety, depression, insomnia, ADHD, and/or for parents/caregivers. Apps Smiling Mind: A free app created to help young children, youth, parents, and school professionals practice daily meditation and mindfulness exercises. Headspace: A paid app designed for people of all ages to learn to meditate and live mindfully. CALM : A paid app designed to help people sleep, meditate and relax. Websites Anxiety Canada : a nonprofit organization whose mission is to increase awareness and promote education about anxiety disorders, increase access to evidence-based treatment, and encourage and develop new treatments and delivery. Anxiety Canada has many handouts and video clips with experts in childhood anxiety explaining the different types of anxiety disorders with tips for children, adults, parents, and educators. Anxiety Canada also has other video clips with real students describing their struggles and ways they learned to cope with anxiety and a free online anxiety management program. EASE (Everyday Anxiety Strategies for Educators): For Educators : a collection of evidence-informed anxiety management and resilience-building resources for use with B.C. students in grades K-7. The resources use cognitive behavioural strategies to address the thoughts, feelings and behaviours associated with anxiety. These resources were co-developed by Dr. Juliana in partnership with Anxiety Canada and MCFD. For Parents : To help support learning across environments, fun and practical EASE lessons have been adapted for use by parents and caregivers to help children manage worries and anxiety at home. Kelty Mental Health: An organization that helps families across the province navigate the mental health system, listen and offer peer support, and connect them to resources and tools. Child Mind Institute: This independent, national nonprofit organization provides information about mental health disorders to families and educators. Anxiety in the Classroom : Sponsored by the International OCD Foundation, this website offers helpful information, resources, and materials about anxiety and OCD as they relate to the school setting. It also provides specific tools for teachers, administrators, and other school personnel who may work with students with anxiety and OCD. Parents and students can also find tools and information to help them advocate for school accommodations, as well as to educate their teachers and classmates about OCD and anxiety. Anxiety and Depression Association of America : This organization offers excellent information on anxiety strategies to be implemented at home and in schools and research-based information for children, adolescents, parents, and professionals. Teen Mental Health: This interactive website provides mental health literacy for teens and school professionals, including slides and handouts. It has entertaining animations to help teens better understand mental health disorders. Enhance your learning about anxiety (click on the links below) Learning about anxiety in schools Information for children Information for youth Learn about the Fight-Flight-Freeze response Video for young kids Video for teens Video for adults Learn about Exposures How to do them Examples of fear ladders Maximizing exposures for anxiety: article and interview Learn about Family Accommodation Recognize and reduce it Evidence-based guidebook for parents based on the SPACE program Excessive reassurance-seeking strategies School Resources Podcast about school accommodations for students with anxiety and OCD provided by Dr. Juliana The Vaccination CARD Toolkit (Comfort, Ask, Relax, Distract) is a science-based, proven framework for helping prepare children for stressful events such as school-based vaccinations, presentations, and examinations. Webinar about School Refusal Brain Health Videos The Teen Brain by Dan Siegel How stress affects your brain The importance of sleep Selective Mutism (SM) SM Information: Selective Mutism Association Anxiety Canada Child Mind Institute A psycho-educational 10-minute video that explains selective mutism and shows effective strategies that can be used by caregivers, teachers, and friends in various settings Training: Free Selective Mutism Training for Parents and Educators Free phone-based coaching is offered by the BC government to families who have children between ages 3 and 12 years with mild anxiety symptoms. SM Activities & Games Separation Anxiety Disorder Video for children and teens Video for parents of kindergarteners Panic Disorder Video Social Anxiety Disorder Video Handling criticism Phobias General information Fear of vomiting- resources Fear of needles - resources Anxiety Booklist Breaking Free of Child Anxiety and OCD: A Scientifically Proven Program for Parents by Eli Lebowitz The Anxiety Workbook For Kids: Take Charge Of Fears And Worries Using The Gift Of Imagination by Robin Alter and Crystal Clarke The Anxiety Workbook for Teens: Activities to Help You Deal with Anxiety and Worry by Lisa M. Schab Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child's Fears, Worries, and Phobias by Tamar E. Chansky