New Client

Capacity for new clients depends on the type of therapy required and the client’s availability for sessions. Please complete the form to provide information about the services you need. Once submitted, you will be contacted to discuss the next steps. This may include offering an initial session or adding you to a waitlist.

Client Name

First Name

Last Name

Client Age

Person completing this form

(if completing on behalf of the client)

Email

Phone

(###)

###

####

Session type

Select the type of session you prefer: 'Mobile' for in-person sessions at home, or 'Telehealth' for online sessions.

Availability

Consider your availability AND being able to engage in sessions. If the times you indicate are not available, you can choose to be put on a waitlist. Operating hours Monday: 9:00am - 5:00pm Wednesday: 8:00am - 4:30pm Thursday: 8:00am - 4:30pm Friday: 8:00am - 2:00pm

Supports required

New Client

Location

Hours

Contact