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BECOME A NEW CLIENT

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Fill out the New Client Form and get matched with a therapist 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 and email if different than above

What services are you looking for?*

Psychotherapy

ADHD Assessment

Full Diagnostic Assessment

Other

Are you looking for virtual or in-person sessions?*

Virtual

In Person

Both work for me

Briefly describe your presenting concerns:*

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

Please provide the amount of insurance coverage you have (e.g., Psychologist, Social Worker, Psychotherapist):

Our team includes Registered Psychologists, Supervised Doctoral Clinicians, and MSW interns. Which clinicians would you feel comfortable working with? (select all that apply):*

Registered Psychologist ($250-280)

Supervised Doctoral Clinicians ($225)

MSW Intern ($150, sliding scale available)

Our team includes both male and female clinicians. Do you have a preference regarding your clinician's gender?*

No preference

Prefer a male clinician

Prefer a female clinician

How did you hear about us?*

Google Search

Social Media (e.g., Facebook, Instagram)

Ontario Psychological Association

Psychology Today

Word of Mouth

Other

Referral by a Health Professional (enter name):

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

Before submitting this form, please review the following information:

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