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604-313-3791
jennifernagel1@yahoo.com
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Jennifer Nagel

CONTACT

Client Forms

If you are new to therapy or counseling, please be sure to fill out the following forms, and bring them to your first session. This will help ease you into therapy and allow as much time as possible to focus on you.

Client Intake

Client Contact Information

Consent for Treatment and Disclosure Form

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information

Jennifer Nagel

604-313-3791
jennifernagel1@yahoo.com

15388 24th Avenue Suite 202
Surrey, B.C. V4A 2J2

White Rock Office Location
Peace Portal Counselling Centre

15128 27B Ave
Surrey, BC V4P 1P2
www.peaceportalcounselling.com

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