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New Client Intake — Step # 1 

 

You are completing the intake form: NEW CLIENT INTAKE QUESTIONS (STEP #1) START HERE 

Please take a moment to fill out our online intake form before your visit, this is the first step to getting connected with the right therapist .You have several options, you can either complete the intake form below or reach out to our client care team by phone to speak to someone directly. Our care coordinator will match you with therapists based on your challenges, goals and personal preferences.  Let’s take the first step, together. All information is kept completely confidential.

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Date of Birth
How did you hear about us?
Friends
Social Media
Web Search
Psychology Today
Womens Show
Other
What are you interested in?
Individual Therapy
Couples Counseling
Therapy for Child (ages 8+)
Therapy for Teen
Family Therapy (2 or more)
Lower cost therapy
What is the best availability for your therapy appointments
I have a flexible schedule and can make most times work for therapy.
I require weekday evenings (after 5:00 pm)
I require weekday daytime between 9:00 am and 5:00 pm
I require weekends
I could do evening (after 5:00 pm) or weekends
I have limited flexibility and need to provide specific times
What services are you covered for?
Registered Social Worker RSW, MSW
Registered Psychotherapist RP
Im not sure
If you have insurance coverage and would like to know if we can DIRECT BILL on your behalf. Please let us know.
Yes
No
Not sure
Are you looking for a therapist of a specific gender
Yes
No preference
Psychotherapy for You is not a CRISIS service. Dial 988 at any time in CANADA. For additional resources click here: https://www.psychotherapyforyou.ca/mentalhealthresources
I am not dealing with an immediate safety concern.
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