Please fill out this Intake Questionnaire in order to be added to our waitlist. For information on expected wait times for services, please contact us.

After filling out the form, you will receive a Welcome Email from our booking system "Jane" within 48 hours.

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Intake Questionnaire

Filling out this form will help us match you with the right clinician, efficiently find an assessment timeslot that works for you, or get your questions answered

Thank you!

Main Areas of Concern (Check all that apply):
Scheduling and Location Preferences (Check all that apply): *Please note that the more flexible you are, the sooner you would likely be seen.
Please check all that apply:

Thank you! For information on expected wait times for services, please contact us.