BOOK AN APPOINTMENT

Welcome
Please complete the fields below so we can guide you to the appropriate service. Required questions are marked with an asterisk (*). Do not include urgent or highly sensitive information in this booking form.

Legal first name *

Legal last name *

Preferred name:

Date of birth *

Email *

Phone *

By checking this box, I consent to receive transactional messages related to my account or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & data rates may apply. Reply HELP for help or STOP to opt-out.

May we send appointment reminders? YES / NO *

Email and text

Text only

Email only

Please contact me to arrange

WHAT CAN WE HELP YOU WITH?

Preferred appointment format: *

In-person

Hybrid

Virtual

Not sure

In one or two sentences, what would you like support with?

Are you a new or returning client?

New client

Returning client

MENTAL WELLNESS SUPPORT

Complete this section if you selected counselling or therapy.

Do you intend to submit your receipts to an insurance or employee benefits plan? Coverage varies. Clients are responsible for confirming eligibility directly with their insurer.

Yes

No

Unsure

MENTAL WELLNESS COACHING & SIGNATURE PROGRAMS

Complete this section if you selected mental wellness coaching.