Consultation Intake Form

Doherty Fultz Immigration offers one-on-one consultations by video conference, phone, and in person to address your immigration questions. All consultations are with a licensed immigration consultant and last up to one hour. In order to book a consultation, we ask that you please complete the following form. After submitting the form, we will contact you to arrange an appointment.

Full Name *

Email *

Phone *

Date of birth *

Street address *

City/Town *

Province/State *

Zip/Postal *

Gender *

Preferred Pronouns (if applicable)

Highest level of education completed *

English Language Ability *

None

Basic

Intermediate

Advanced

Fluent/Native Language

French Language Ability *

None

Basic

Intermediate

Advanced

Fluent/Native Speaker

Have you taken a language test in the past 2 years? *

IELTS

CELPIP

TEF

TCF

None

Have you already received an ECA Educational Credential Assessment such as WES? (Economic Immigration Only) *

Yes

Not Applicable

Occupation *

Employer’s name *

Nationality *

Country of residence *

Status in Canada (if applicable)

Expiry Date In Canada (if applicable)

Have you ever submitted any immigration application to Canada before? *

Yes

Have you ever had any type of immigration application refused to Canada OR any other country such as the US? *

Yes

Do you have a Spouse/Common-Law Partner?

Spouse

Common-law partner

Spouse/Partner’s Name (if applicable)

Spouse/Partner’s Nationality

Spouse/Partner’s City and Country of Residence

How long have you been married or in a common-law relationship?

Does your spouse/partner speak English or French?

English

French

Both

Neither

Spouse/partner’s Age

Have you or your spouse ever been placed in handcuffs, detained by police, arrested, charged with a crime, or convicted of a crime? *

Yes

Which type of immigration matter best describes what you wish to discuss during your consultation? *

PR Through Express Entry or other Economic Stream

Family Sponsorship

PR using any stream available

Humanitarian and Compassionate Case

PR Card Renewal/Residency Obligation Issue

Work Permit and/or LMIA

Visitor Visa

Study Permit

Canadian Citizenship

Procedural Fairness Letter

Misrepresentation

Other

Please briefly describe you immigration matter so we can assist you *

How did you hear about us? *

Referred by a friend or family member

Google search/maps/reviews

MPOWER

Returning Client

Facebook

Instagram

Moving 2 Canada

BNI

VisaWire

Youtube

Tiktok

By typing my name, I hereby certify that this document is legally executed by the person named herein as the Client, and that I understand and acknowledge all of the above information to be true, correct, and complete. *

Today’s Date *

By signing above, I indicate that I understand I am obliged to pay a consultation fee of CAD$199 HST Included (clients inside Canada) or USD$199 (clients outside Canada) per hour of consultation over video conference or telephone; for up to one hour in person with a Senior Consultant I am obliged to pay CAD$450 + HST. I understand that all consultation fees must be paid at the time of appointment booking, and consultation fees paid are non-refundable for missed or cancelled appointments. I understand that all quotes given for services at the time of a consultation remain valid for 90 days as long as no circumstances discussed during the consultation change.

I understand that, per the legal requirements of the College of Immigration and Citizenship Consultants Act, Doherty Fultz Immigration will request a copy of my photo ID at the time of scheduling my consultation appointment.

I understand that, with the exception of correspondence received from IRCC, Doherty Fultz Immigration will not review application forms or supporting documentation during a consultation. In order to book an application review, a separate review form must be completed by the applicant.

I understand that a maximum of 2-3 simple follow up questions are permitted as long as they are submitted within 5 days of the consultation and pertain to the consultation. Any questions that fall outside these parameters will require a new paid consultation.

All information discussed or disclosed in the context of a consultation at Doherty Fultz Immigration is STRICTLY CONFIDENTIAL, and is bound by representative-client privilege. These terms and conditions shall be governed by the laws in effect in the Province of Ontario, Canada.

Please be advised that Cassandra Fultz (R514356) and Marcia Freese (R708661) of Doherty Fultz Immigration Inc. (located at Bloor Islington Place, 3280 Bloor Street West, Suite 1140, 11th Floor, Centre Tower, Toronto, Ontario, M8X 2X3; Telephone: 416-827-8778; email: [email protected] ) are members in good standing of the Immigration Consultants of Canada Regulatory Council (ICCRC)/College of Professional Immigration Consultants, and as such, are licensed and regulated by this organization and are bound by its By-laws, Code of Professional Ethics, and associated Regulations.

By signing this initial consultation agreement, you acknowledge that any interaction with IRCC or CBSA undertaken by you without retaining an Doherty Fultz Immigration RCIC as a legal representative is done at your own risk, and Doherty Fultz Immigration accepts no responsibility for the outcome of any such interaction.

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Intake Form – Consultation