Therapist Matching Survey

1
Full Name* This field is required.
First Name
Last Name
2
Email* This field is required.Please enter a valid email address. You will be sent a confirmation email.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
3
Are You Seeking Individual or Couple's Therapy?* This field is required.
Individual Therapy
Couples Therapy
Family Therapy
4
I am looking for:* This field is required.
Online Virtual (Ontario Wide)
Hybrid
In Person (Toronto - Bay/ College)
Undecided
5
Already know which therapist you'd like to meet? Let us know!This is an optional question, leave blank if you'd like us to match you with one of our therapists. Skip if you'd like to be matched based on responses and clinician expertise.
6
What Issues Are You Seeking Treatment For?Check all that apply
Trauma
Neglect & Abandonment
Grief & Loss
Life Transitions
Emotional Regulation
Gender & Identity
Perfectionism & High Performers
Men's Mental Health
Body Image & Self-Esteem
ADHD
Compassion Fatigue & Burnout
People Pleasing & Boundary Setting
Narcissism in Relationships
Personality Disorders
Eating Habits & Disordered Eating
Addictions
Other
7
It Is Important That My Therapist...Check all that apply
Helps me feel heard and understood.
Provides practical tools and strategies for my challenges.
Supports me in managing stress and anxiety.
Helps me explore and process past traumas.
Is compassionate and non-judgmental.
Works with me to improve my relationships.
Supports me in setting and maintaining boundaries.
Helps me build confidence and self-esteem.
Is flexible and adapt to my evolving needs.
Understands and supports my gender identity and/or sexuality.
Guides me in addressing patterns of behaviour I want to change.
Helps me navigate life transitions or big changes.
Other
8
What are your goals for therapy?
Reduce stress or anxiety
Improve mood or overcome depression
Build self-esteem or confidence
Address trauma or past experiences
Improve relationships and communication
Learn coping skills for life challenges
Manage anger or emotions more effectively
Explore identity or personal growth
Other
9
Do you have private insurance? * This field is required.Ensure that your provider covers services provided by the health care provider (psychotherapist and/or social worker)
YESNO
10
What Best Applies to Your Situation? * This field is required.
I am comfortable with the standard rate for therapy ($150 individual; $225 couples)
I'd like to discuss a limited sliding scale option based on financial need ($90 to $125 individual; $150-$180 couples)
I am interested in lower cost therapy ($40-90) with a student intern
11
Is There Anything You'd Like Us to Know?
12
Please verify that you are human* This field is required.By submitting this form you consent to a team member contacting you to set up a 15 minute consultation.
Should be Empty: