Intake Form

Speak With Us

Thank you for taking the time to complete our intake form below, this will help with our intake process and to connect you with someone as soon as possible. 

Before completing the form, please note the following regarding our services and fees:

 – Our services are not covered by OHIP
 – We are not able to offer sliding scale fees at this time
 – We do provide direct billing services wherever possible
 – Our fees are:

  • Psychologist $250 per session
  • Registered Social Worker/ MSW/ Registered Psychotherapist $160-225 per session
  • Clinical Associate (MA/ MPsy/ MSW supervised by Lead Clinical Psychologist) $160-175 per session
  • Career Coach $100 per session

 

Intake form
Please tell us who you are completing this for:
Name
Name
First
Last
What is the best way for us to contact you?
Age group:
What kind of appointments are you looking for?
Which profession are you looking to see? (If you have insurance/ health benefits, please check your plan)
We do direct billing wherever possible. If this is something you’re interested in, please let us know your insurer:
By submitting this form, you consent for us to collect, store, and share your personal health information with our intake coordinator and therapists.
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