Submission Form for Private Psychology Appointments

What brings you to psychological support at this time? Is there something specific, such as a particular event?*
What are you hoping to find from this support? (Goals)
Please provide an overview of any support you already have in place now.
What else would you like us to know?

Please tick the box to confirm the following:

Your appointment will be completed online. An initial appointment of up to 75 minutes is $345, paid prior to the appointment. Follow up appointments per 50 minute session are $285, paid prior to the appointment.
Should be Empty: