Please fill out this Questionnaire. Any information you give to us during this process is handled in strict confidence. We cannot and do not release your personal information to anyone without your permission.
Of course, no one can completely guarantee that information sent to us over the internet will be perfectly confidential. If you wish, you may print this form (click here) and send it by fax to us at (250) 590-3592.
Please answer our questions as fully as you can. If you do not know the answer to a question, please say so or type in “d/k”. We will review your assessment and contact you by email to discuss how we can help you. Depending on your answers, we may have one or two follow-up questions for you.
This Assessment is entirely free of charge to you.