Get matched with a therapist
This form helps us understand what you’re looking for so our team can connect you with the most appropriate provider. This is not a booking form. Once reviewed, a member of our team will follow up with next steps.
What are you looking for support with? (Please select all that apply)
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Career Counselling
Public speaking anxiety
Self-confidence
Workplace stress or relationship challenges
Goal-setting and concentration
Presentation Coaching
Interview Coaching
Other
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Which province are you currently located in?
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Ontario
Nova Scotia
Other
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Full Name
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First Name
Last Name
Email Address
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Is this a Canadian phone number?
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Yes
No
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What best describes your current role or occupation?
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When are you generally available for appointments? (Select all that apply)
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Weekday mornings
Weekday afternoons
Weekday evenings
My availability varies
My schedule is flexible
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What brings you here today? Feel free to share up to 3 things you’re working on, wondering about, or trying to tackle.
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Would you be interested in group therapy?
Yes
No
Maybe / open to learning more
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How did you find us?
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Google search
Psychology Today
Referred by family or friend
Referred by physician or healthcare provider
Instagram
AI querie
Other
Please share the name of the physician or healthcare provider who referred you.
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I understand that this form will be reviewed by the administrative team at Amanda Tobe & Associates and shared with a provider for the purpose of follow-up. I consent to the provider taking notes during an introductory consultation.
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Agree
Disagree
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I confirm that I am between the ages of 19–65 and currently reside in Ontario or Nova Scotia.
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Agree
Disagree
Submit
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