Pre-fill your NIHB form

Optional · saves time at your first session

Pre-fill your part of the NIHB counselling form.

Counselling through NIHB uses an official government form (the Mental Health Counselling Services Prior Approval/Claim Form). Your counsellor completes most of it, but the client information section is yours. Fill it here, download the PDF, and bring it (printed or on your phone) to your first session.

Nothing is signed here. Signatures happen in person, at your counsellor's office, the way the form intends.

This page never sends anything. The form is filled entirely on your own device and the PDF downloads straight to it. Your status number, birth date and address do not touch Wapan's systems. We never see or store them.

Surname

Given name

Address

Apt.

City

Province/Territory

Postal code

Phone number

Client identification number

First Nations: your 10-digit registration (status/Treaty) number. Inuit: your N-number or territorial health card number.

Date of birth (YYYY-MM-DD)

Downloaded. Bring the PDF to your first session, printed or on your phone. Your counsellor fills in their sections, and you sign together in person.

Or download the blank form