• Therapy Request 

    Welcome to the Julia Ryan Psychology 

    This is a short request form — about 10–15 minutes. It helps our clinical team identify a clinician to fit your needs before you complete the further intake steps.

    You'll hear back from us within 2 business days of submitting this form. Our clinical director will review your request to determine which of our available clinicians would be a good fit, and you'll have the opportunity to request a specific clinician or to prioritize lowest cost. We do not keep a waitlist for therapy — if we're unable to offer you a suitable clinician right now, we'll provide referral options.

    Therapy is currently open for {ageRangeString}

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  • [H] Is Client 50+ km from office?
  • [H] Date today
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  • [H] CLIENT AGE

  • [H] Is Client in valid age range?

  • [H] CLIENT TEXT / STRINGS

  • [H] CLIENT LANGUAGE

  • [H] Is Client nonverbal
  • [H] Is Client's native language English?
  • [H] Is Client fluent in English?

  • [H] INSURANCE

  • [H] Direct billing requested?
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  • [H] FILE UPLOADS

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  • Overview

    Therapy (also referred to as psychotherapy, counselling or intervention) is a collaborative, goal-oriented process that supports individuals in understanding themselves, strengthening skills, and making meaningful changes in their lives. Therapy is tailored to each person's unique needs, strengths, and developmental context, and may address emotional wellbeing, mental health concerns, learning or executive functioning challenges, relationships, identity, or life transitions.

    Our work together may include developing insight into patterns of thinking, feeling, and behaviour; building practical coping and regulation strategies; strengthening communication and problem-solving skills; and supporting growth in areas such as confidence, autonomy, and resilience. Therapy is flexible and integrative, drawing on evidence-based approaches and adapting over time as goals evolve. When helpful, collaboration with families, schools, or other professionals may be incorporated to ensure support extends beyond the therapy room. 


  • Overview

    Therapists

    Our team is made up of regulated mental health providers from a range of professional, training, and practice backgrounds. This diversity allows us to bring varied perspectives, clinical expertise, and approaches to our work, while maintaining a shared commitment to ethical, evidence-based, and client-centred care.

    Our clinicians include fully licensed practitioners as well as supervised trainees who are completing advanced clinical training. All services provided by trainees occur under the close supervision of experienced, regulated clinicians, ensuring high standards of care, collaboration, and ongoing professional development across our team. 

  • LANGUAGE

    Our clinicians are primarily English-speaking. If the Client is more comfortable communicating in another language, we may not be the right fit.

  • Fees and Payments

    The fees at Julia Ryan Psychology vary by clinician and service.

    For Therapy Services

    Fees vary depending on a clinician's training background and experience, ranging from $130 to $275 per hour, with the lower end representing student trainees and the higher end experienced Ph.D.-level psychologists providing specialty care. A clinical hour is typically 50 minutes of direct contact.

    Billable Fees

    All service fees apply to direct client contact, as well as non-contact clinical work such as preparing documentation, consulting with other professionals, and completing forms. 

    Payment

    We accept credit card for payments, as well as direct billing for some insurance plans. 

    We require a credit card on file for all clients.

  • Fees and Payments

    Payment does not mean Access to Information.
    Privacy legislation regulates who can access a Client's information and under what circumstances. If someone other than the Client or legal guardian is paying for service for a mature minor or dependent adult, they are not entitled to accessing the Client's health information including details about scheduled appointments, treatment plans, or clinical findings.

    Cancellations and Missed Appointments
    If the client cancels the appointment without 48 hours of advanced notice or does not show up, we will apply a late fee of 50% of the session fee. A late penalty of $5 per day applies to overdue payments and is added to the next invoice; subsequent sessions will not be scheduled until previous balances are paid.

    Exceptions may be made for illness, quarantine/self-isolation, or other extenuating circumstances at the discretion of the clinic.

  • Fees and Payments

     

  • We are recognized with the Employee Assistant Program for Public Safety Canada. We may accept other third party funding. Please indicate below if you wish to pay for part or all of your services through EAP or third party funding:

  • Depending on your insurance policy or work arrangement, health insurance and employee assistance programs (EAPs) may not cover the entire cost of our mental health and psychological services.

  • Your Information (Submitter)

     

  • Who are you submitting this therapy request for?*
  • What is your relationship to the Client?
  • Format: (000) 000-0000.
  • Have you recently or previously completed an assessment with us, or are you currently on our assessment waitlist?*
  • How did you hear about Julia Ryan Psychology?

  • The Client: who the therapy is for

    Throughout this form, the individual to be receiving therapy will be referred to as the Client.

    The information below will be used to create the Client's official file. Please enter the details (name, date of birth, etc.) for the individual who is receiving the services.

    If you are submitting this form for someone else, do not use your own name or date of birth in these "Client" fields. Doing so will create an incorrect file and will require us to resend the form for correction.

  • Client's date of birth*
     - -
    • Queensview Professional (all ages)
    • Sherwood Psychology (all ages)
    • Centre Dimensions (all ages)
    • OCFR (all ages)
    • Diverse Minds Counselling (adults)
    • Child in Mind (children, adolescents, and families)
    • NPSCSPN (children, adolescents, and families)
    • OCATT (children, adolescents, families, and adults)
    • Connections Psychology (children, adolescents, and adults)
    • Madison Strong (adolescents, adults, and couples)
    • Uprise Psychology (teens and adults)
    • Kim Hsiung (adolescents and adults)
    • Bloom & Grow Psychotherapy (children)

  • The Client: who the therapy is for

     

  • Format: (000) 000-0000.
  • Sex assigned at birth*
  • Gender identity*
  • Preferred pronouns*
  • Which racial or ethnic category(ies) best describes the Client? Select all that apply
  • School/Work: Please select all those that apply currently

  • Custody, Guardianship & Consent

    We have determined this section does not apply for you, please go to the next page.

  • Custody, Guardianship & Consent

    Why we ask: When seeking mental health services for a child, we need consent from everyone who holds legal decision-making authority for the Client. "Custody" here means legal medical decision-making rights — which isn't always the same as who the child lives with. Getting this right up front prevents delays later.

     

    If your family situation is complex and this policy does not fit well with your circumstances, we encourage you to contact us before completing this form so we can discuss your situation and determine whether our clinic is the right fit. You can reach us at admin@drjuliaryan.ca or 613-699-0825.

  • What is your current relationship status with the Client's other parent?*
  • Is the Client adopted?*
  • Is the Client currently in society care?*
  • Is the Client currently with a guardian other than their birth parents?*
  • Do you have sole legal custody of the Client or do you share joint legal custody with the other parent?*

  • Consent from all legal guardians or custodial parents is required

    Where more than one adult shares guardianship or custody of a child, all parties have a right to consent to or deny the service.

    We will ask for the name and contact information of a second parent/guardian for all clients under the age of 16 to ensure both parents/guardians have the opportunity to be aware of and/or participate in the services. 

    We will email the other legal custodian once your therapy request is submitted so they are aware of your request and have the opportunity to contribute.

  • Other legal guardians

    We will ask for the name and contact information of a second parent/guardian for all clients under the age of 16 to ensure both parents/guardians have the opportunity to be aware of and/or participate in the services. 

    We will email the other legal custodian once your therapy request is submitted so they are aware of your request and have the opportunity to contribute.

  • Format: (000) 000-0000.

  • Mature Minors and Dependent Adults

    Seeking services for a dependent

    When you're seeking services for someone in your family — a child or another person you care for — a few things simply work a little differently depending on the person's age and capacity.

    We want to partner effectively with the caregivers in a client's life, and we'd like to make sure now that you are aware of some of the important considerations for dependents who are of an age to make their own decisions about their care.

    What to expect

    From around age 12, and certainly by 16 and older, the person receiving services is expected to be actively involved in their own care. This includes:

    • Consent for the service and different aspects of it
    • Agreeing to who gets to be involved
    • Deciding how information about them is collected from others and shared

    This doesn't mean we set parents and caregivers aside. In these cases, families and caregivers are usually central to a Client's life, and their involvement often strengthens the work. We aim to collaborate with clients and their caregivers together, because we know outcomes are stronger when the people who support a client are part of the work.

    For ages 12 to 16, we strongly encourage parents and youth to attend the intake meeting together. For ages 16 and older, the client completes their own intake forms and attends their own intake meeting, with caregiver involvement welcome and encouraged wherever it's supportive. That includes this form and subsequent intake forms and intake meetings - clients age 16yo+ should participate in completing this form if possible; at minimum they must be aware of the request and the information you are sharing, but where possible

    As services unfold, the clinician helps guide ongoing decisions about caregiver involvement and information sharing depending on the client needs, service goals, family dynamics and family logistics. This will look different for each client; there is no one size fits all, but the one thing that stays stable is that our clinicians support Client autonomy and decision-making processes with their best interest in mind, which includes recognizing the importance of families and planning carefully for caregiver involvement.

    We respect the role of caregivers, and we also respect the client's right to decision making. Where joint meetings or collaboration among clients and their caregivers may be difficult or challenging, we consider how best to include everyone in a manner that respects the client's autonomy and the important role of caregivers. 

    We do not force or coerce clients to participate in services, to work on specific goals that they do not buy in to, nor to share information with us or with others they are not comfortable sharing. We also do not withhold information about them from them; the information gathered about a client — in this form, and in later intake forms and meetings — is available to them. This means clinicians cannot hold information received from caregivers in confidence from the client. These boundaries are required by law. They protect the client's autonomy, which builds their trust in us and ultimately supports more effective services.

  • Youth and adults ages 16yo+ make their own decisions about their involvement in therapy and must be the ones to consent and participate, including for this request. A caregiver or partner is welcome to help, but the Client needs to be actively involved in this request.*

  • Please contact us at 613-699-0825 or admin@drjuliaryan.ca before completing the form to discuss this

  • Eligibility

  • Residency Requirement

    We are only licensed to serve residents of Ontario, or Quebec if they can travel to our office in Ottawa. If you are not a resident of either province, we cannot provide therapy to you or your dependent.

  • Are you an Ontario or Quebec resident?*
  • Client's primary address*

  • Your distance from Julia Ryan Psychology

    It looks like you live 50 kilometers or more from our office; please be mindful that you may need to travel for any in-person appointments.

    If you'd like to inquire further before proceding, please email admin@drjuliaryan.ca

  • What is the Client's native or primary language?*
  • What languages, besides their primary language, is the Client fluent in?*

  • Please note that our clinicians are primarily English-speaking and our services are delivered in English. If the Client is not fully comfortable in English, please contact us to discuss whether we can meet their needs or help arrange a suitable referral.

  • List any other languages the Client can understand at a basic level

  • Reason for seeking therapy

  • Have there been prior professional assessments (psychology, OT, speech, etc)?*

  • Please start to gather copies of these prior assessments as we will be requesting them. Likewise, children, youth and adults alike will be asked to submit copies of their report cards to support a review of academic history. You should also begin gathering those at this stage.

  • Did you receive a referral for therapy from another health care professional (doctor, therapist, OT, etc)?
  • Is the above named individual involved in ongoing care?*
  • Do we have permission to contact this individual to coordinate care?*
  • Format: (000) 000-0000.
  • What are you hoping to gain from therapy? (Pick your top 3)*
  • What format do you prefer for your therapy sessions?*
  • Date*
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