New Client Form

Thank you for your interest in the Toronto Psychology Clinic!

In order to book an appointment with one of our therapists, please complete the following screening form to share more information about your therapy needs.

Once received, a member of our intake team will get in contact with you regarding next steps and booking an intake call. During the brief 15 minute intake call, our team will be able to collect more information surrounding your needs as well as provide you with information regarding therapists availability and waitlists. If you have a preference for working with a specific therapist, please let the intake assistant know at the time of the call. If not, we will match you with a therapist based on your needs and availability.

By completing and submitting this form you are confirming that (1) you are interested in becoming client at the Toronto Psychology Clinic, (2) We have your permission to store the information you provide us in our secure online database and (3) that someone from our clinic can contact you at either the email or phone number provided.

Your Information

Name

Age Range

E-mail

Phone

Please note that if there is a voicemail option, we will leave you a voice message. Please do not provide a number where you do not want us to leave you a voice message.

Format

Select your therapy format.

Format

In-Person counselling is not being offered at this time.

Treatment

Select all that apply

*Please note there is a wait list for couples therapy

Primary Presenting Issue

Availability/Scheduling

Preferred Therapist

Intake Call Availability

Client Acknowledgement

Please note that wait times for an initial appointment can vary from 2 weeks to a few months and depends on the therapist you are requesting or who is the best fit for you. All therapists at this time are providing virtual services only. Initial to indicate you understood:
We do not offer sliding scale and are not OHIP covered. Our fees for therapists are as follows $250-275 for a Registered Psychologist/Psychological Associate, and 160-190 for a Registered Social Worker/ Psychotherapist. Initial to indicate you understood:
We do not provide: Legal assessments (e.g. court-mandated or immigration-related, etc. assessments), ADHD, Autism, and Neurological assessments/diagnosis, WSIB or MVA assessments or treatment, Substance Use problems that are primary. Initial to indicate you understand:

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