Inquiry Form

Please fill out the following form.

First name

Last name

Phone

Email

Will you be physically located in Ontario at the time of appointments?

Yes

No

Are you available for appointments during regular business hours?

Yes

No

Is your preference to have a 15 minute consultation before booking an intake appointment?

Yes

No

No preference

Are you looking for:

Individual Therapy

Couple Therapy

Please note that I do not work with the following issues:

If they happen to come up later in therapy, I would help you find a more appropriate referral.

*Please check the box to confirm you have read and understood.