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Get Started!

Looking for support?


At Northern Outreach and Clinical Services (NOCS), we’re here to help.

 

Please fill out the form below and a member of our team will get back to you as soon as possible to discuss your needs and how we can best support you.

Name of Person Completing This Form

Contact Information

Relationship to the Person Seeking Services
Self
Parent
Guardian
Other
Age of the Individual
0-3 years
4-6 years
7-12 years
13-17 years
18-24 years
25+ years
Service(s) of Interest (check all that apply)
Preferred Service Setting:
How Did You Hear About Us?

Consent & Privacy

By submitting this form, I understand that: 

  • The information I provide will be used by Northern Outreach and Clinical Services (NOCS) to respond to my inquiry about services. 

  • This form is not a treatment agreement or consent for service. 

  • NOCS complies with the Personal Health Information Protection Act (PHIPA) and will keep the information I share confidential, using it only to contact me about services. 

  • I may withdraw my consent at any time by contacting NOCS. 

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