HHA Therapist Matching Program
Let us help to connect you to a suitable therapist!
Personal Information
Full Name
*
First Name
Last Name
Student Number
*
Preferred Pronouns
*
Please Select
She/ Her
He/ Him
They/ Them
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
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Therapist Preferences
What qualities do you look for in your ideal therapist?
How would you like to meet with your therapist?
*
Please Select
In-person
Online- Video
Online- Voice only
Hybrid
If in-person, how far away could you travel for your therapy sessions?
Please Select
<1km
1-10km
10-20km
Any distance
Do you have a gender preference?
*
Please Select
No Preference
Yes- Female
Yes- Male
Yes- Non-binary/ Other
Do you have an age preference?
*
Please Select
No Preference
Yes- 20-30 y/o
Yes- 30-45 y/o
Yes- 45+ y/o
Select your preferred price ranges (per session)
*
Low ($40-60)
Mid ($60-80)
Standard ($80-100)
Experienced ($100+)
Any additional preferences? (i.e. racial identity, religious affiliation, etc.)
Submit
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