Let's Get Started

Please complete the Intake Form with information about you and what you are looking for. We will get back to you within 24 hours.

Client First Name*

Client Last Name*

Email*

Phone

Client Age*

Client Gender*

Are you completing this form on behalf of someone else (such as a child)?

Yes - please add your name:

What services are you looking for?*

Individual Psychotherapy

Diagnostic Assessment

ADHD Assessment

Skills Group

Other

Are you looking for virtual or in-person sessions?

Virtual

In-person

Both work for me

Briefly describe your presenting concerns:*

Have you had therapy/assessment in the past?

Yes

Please list your general availability for sessions (days & times):*

Is there any additional information you would like us to know?

How did you hear about us?*

Google Search

Social Media

Ontario Psychological Association

Word of Mouth

Other

Referral by a Health Professional (enter name)

Before submitting this form, please review the following information:

If we require any follow-up information, we may ask to schedule a brief call or follow up via e-mail for further information.
Please expect to hear back from us within 24 hours with a therapist and/or treatment recommendation.
Please note that e-mail and contact forms are not secure forms of communication. Your use of this contact form confirms that you accept this risk.

Address: 234 Eglinton Avenue East, Suite 503, Toronto, ON, M4P 1K5

Phone: (226) 793-2340

Fax: (855) 234-9716

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