top of page

New Client Intake Process – Step 1

 

Please take a moment to fill out our online intake form before your visit. This new client intake process 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.​

In Canada add (1) before you phone number.

Date of Birth
Month
Day
Year
How did you hear about us?
Friends
Social Media
Web Search
Psychology Today
Women's Show
Spotify
Other
What are you interested in?
Individual Therapy
Couple's Counselling
Therapy for Child (ages 8+)
Therapy for Teen
Family Therapy (2 or more)
Lower Cost Therapy
PSYCHIATRIST
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
I'm 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
I'm 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.
  • TikTok
  • Pinterest
  • LinkedIn
  • TikTok
  • Psychotherapy for You on Facebook
289-205-3505

©2023 by Psychotherapy for You. All rights reserved.

bottom of page