Please remember that if you experience a crisis situation and require immediate assistance, you should contact emergency services or contact us directly 24/7 at 1-800-663-1142 (EN), 1-866-398-9505 (FR).
Employee/Member’s Organization Name
Employee/Member’s Division, Department or Union (if any)
Employee/Member’s job title
My First Name
My Last Name
My Date of Birth
I am the
spouse of the employee/member
dependent child of the employee/member
Employee/Member First Name
Employee/Member Last Name
Employee/Member Date of Birth
Can Homewood leave you a message?
Who would be receiving services?
Spouse First Name
Spouse Last Name
Spouse Date of Birth
Child First Name
Child Last Name
Child Date of Birth
Biological Parents Together
Type of Service
Specialists & Counsellors
Type of Law
Landlord and tenants
Wills and estates
Nature of Services
Nature of Services
Lactose /food intolerance
Wellness/ healthy eating
Please describe the situation you would like to get support about
Are you currently on disability leave?
Yes, on short-term disability
Yes, on long-term disability
Do you (or anyone involved in the situation) have current concerns about your safety?
Have you (or anyone involved in the situation) recently had thoughts of harm to yourself or others?
Are, you or people around you, concerned about your (or anyone’s involved in the situation) use of alcohol or drug use?
Have you been recently impacted by a workplace incident?
What are your general availability for appointments?
Please note that we may contact you (either by email or phone) if additional information is required to complete your request. In all cases, someone will get back to you within 24-48 business hours to coordinate services. If you don’t hear back from anyone, please verify your junk email folder first in case we emailed you, and contact the client services center, available 24/7 at 1-800-663-1142.