By checking this box, I consent to the transmission of the personal information in this web form over the internet. I understand that internet communications are not secure and that this transmission may be intercepted. I consent to Northern Counselling and Therapeutic Services Inc. (NCTS) using the personal information provided in this web form to contact me to to discuss my request for information and/or counselling services. I understand that NCTS uses the information in this web form for the purposes of intake only and keeps this information private from all third parties. I understand that NCTS complies with the federal Personal Information Protection and Electronics Documents Act (PIPEDA) and/or any superseding provincial/territorial privacy act.