simpleCTS
Spend time serving clients, not counting them.
VAST
Add Client Information

Referred by: Contact Person

 
Referred by:
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Referred by: Phone Number

 
Referred By: Email of contact person

 
Referral Date
 
Reason for Referral/Presenting Issue


 
Does this client want Individual Counseling sessions?
 
Is the client taking any medications?
 
What medications are you currently taking?


 
Have you received any VAST services in the past?
 
First Name
 
Last Name
 
Birth Date
 
Gender
Male    Female    Other    Not Indicated GenderQueer    Prefer not to say   
 
Does the client identify as LGBT2SQ+?
 
Chosen Pronoun:

 
Phone Number
 -  - 
 
Is it OK to leave a voice message?
 
Alternate Phone Number
 -  - 
 
Email
 
Address
   Unit
 
City
 
Postal Code
 
First Language
 
Languages Spoken
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Client Country of Origin:
 
Interpreter Required?
 
Family in Canada?
 
If YES? Please identify in box below:


 
Is the client a minor?
 
If the client is a minor, please add Legal Tutor Name/Parent Name and phone number:


 
Where is this client:
 
How long has the client been in Canada?
 
Entry Pathway:
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Immigration status upon VAST intake
 
Landing Date
 
Refugee Hearing date as communicated upon intake:
 
Status of Hearing
 
Type of Hearing
 
Is the referral source requesting an assessment report?
 
Document Deadline
 
Lawyer Name

 
Lawyer Phone

 
Lawyer Email