Ruah Counselling CentreHomePrograms & ServicesStaff & FacilitatorsRequest for Services ProcessFeesContactHomePrograms & ServicesStaff & FacilitatorsContactDONATERequest for ServicesRuah Counselling CentreClient Name* First Last Date of Birth* Date Format: MM slash DD slash YYYY Gender (Self identify)*Address* Street Address Address Line 2 City Province Postal Code May we email you?*Please note that email correspondence is not considered to be a confidential medium of communication.YesNoEmail Best Telephone #*Leave Message?*YesNoSource of RequestSelf OR Name and Address of Agency.*Name First Name Last Name Telephone # of SourceIf not self-request, is the client in agreement with the request?YesNoService Requested:*Individual CounsellingCouple CounsellingFamily CounsellingGroupIf Group, indicate name of groupHow did you become aware of our services?*PLEASE NOTE: Ruah staff member will be in contact with you within five (5) business days for appropriate follow up. Ruah is not a crisis centre. If you require help immediately, please phone the Mental Health Crisis Line at: 1-888-737-4668 or go to your nearest Emergency Department. CommentsThis field is for validation purposes and should be left unchanged.Ruah Counselling Centre Request for Services Process Fees ContactContact Ruah Counselling CentreAddressThe Lantern Building35 Barnes RoadSt. John’s, NL A1C 3X1 DirectorPauline Lake-Devine,MSW, RSWAdministrative AssistantSamantha LakeTel: (709) 579-0168Fax: (709) 579-2799Email: ruah@rcsj.orgCounselling StaffAmelia O'Dea, MSW, RSWSusan Smart,M.Ed. (Couns. Psych.) , CCCElizabeth Belbin, MSW, RSW
