Schedule An Appointment

Thank you for your interest. Please fill in the form and our intake co-ordinator will contact you soon.

 

Please indicate if you are completing this form for yourself * Yes
No

If No, please specify if you are the Mother, Father, Sibling, Health Care Provider, etc. of the prospective client.

First Name *

Last Name *

Age

Gender *

Email Address *

Phone *

Choose the Language in which you need your service:EnglishHindiBengaliTamilMandarinUrdu

Select Time: (Please select all that is applicable) Morning
Afternoon
Evening
Weekends
Weekdays
Flexible with anytime

Reason(s) for your visit:Individual TherapyCouple TherapyFamily TherapyAssessmentsTherapy ApproachesConditions Treated

Location Preference: (Please select all that is applicable) Virtual
In-person

Our services are not covered by OHIP. Will you be using Private Health Insurance? Yes
No

Gender Preference of Clinician:FemaleFemale Preferred (Male OK)MaleMale Preferred (Female OK)

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