Your Name *

First Name

Last Name

Partner's Name (for couples therapy)

You must let your partner know you are requesting couples therapy. This must be a joint decision.

First Name

Last Name

What specific service are you looking for? *

Couples Counselling

Individual Counselling

Couples Intensive (3+hrs)

Free 15 min consultation

Are you looking for an in-person session or virtual session? *

in-person

virtual

either in-person or virtual

Indicate when you would like to request an appointment: *

any time, any day

between 10am and 3pm

Must be 4pm or later

Must be 5pm or later

Must be 5:30pm or later