Registration

Registration

Interested in booking with a therapist in our network? Complete the registration and we'll get back to you as soon as we can! This information will be used to make you an account in the system and, if applicable, to confirm your insurance coverage.
Name*

First NameLast Name
Email*
Confirm Email*
Province*

What university/college do you attend in Manitoba?*
How do you intend to pay for the cost of any sessions?*

Self pay with a credit cardI would like to use insurance
If using insurance, please indicate whose insurance you want to use

My own student insuranceMy parents' insuranceMy work insuranceOther
Do you have insurance through any of the following?
You can review the therapists available to book with by clicking here and then you can return to this tab to answer the next question.
Is there a specific therapist you're interested in booking with?

Are you a university or college student in Ontario?

YesNo
What university or college do you attend?
How do you intend to pay for the cost of any sessions?*

Self pay with a credit card/I'll submit a receipt to my insurance planI would like to use insurance and have you direct bill if possible
If using insurance, please indicate whose insurance you want to use

My own student insuranceMy parents' insuranceMy work insuranceOther
Do you have insurance through any of the following?
You can review the therapists you can book with in our network by clicking here and then you can return to this tab.
Is there a specific therapist you're interested in booking with?

Are you interested in us directly billing your insurance? If yes, we'll need your birth year and student number/certificate number in the next questions. If you do not want to share that information with us, you can pay for sessions with a credit card and submit the receipt to your insurance plan.*

I would like you to direct bill my insurance if possible and I consent to you checking if you're able toI will pay for sessions with a credit card
If you're using student insurance, what is your student number? If you're using other insurance, what is your certificate number? This allows us to check to see if your insurance can be directly billed to.
What is your birth year? (needed to check your insurance)

Based on your answer, the therapists in our network will be unable to direct bill any insurance you have at this time. If you become registered, you will need to add a credit card to your account. You will get a receipt after each session and if you have insurance you can submit it to your insurance plan. Please note that you are responsible for understanding your insurance coverage to know if you have coverage, how much coverage, and what type of mental health provider your insurance will cover.*

I understand

If you become registered, would you like us to call you if you haven't booked a session after a few days to see if you could use help booking a session/picking a therapist or as a reminder?

Yes pleaseNo thanks
What is your phone number?
Please enter a valid phone number.Format: (000) 000-0000.
Make sure to check your junk folder over the next 24 hours in case our email ended up there.*

Will do!
Confirm that you understand My Student Wellbeing is not a crisis service and that if you're ever in crisis, you will call 911 or contact a crisis service.*

I understand My Student Wellbeing is not a crisis service and I will contact a crisis service if I ever need to
Helpful to us (but optional): How did you hear about us? This helps us know what we're doing well in terms of getting our name out there. Thanks!
Please verify that you are human*
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