Intake Form

This form can be completed if you are interested in exploring formal mental health services with a licensed and professionally trained practitioner. Currently, we are only able to connect folks with providers in Canada. 

Please note that all information collected is legally protected and will remain confidential. By completing this form, you are consenting to us sharing your intake form within our professional network for the purposes of finding you a suitable mental health provider.

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While it is not required to complete every section of the form, the more information you can provide, the better we are able to understand your needs and find you a good therapeutic fit.

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If you live outside of Canada, you may find this link helpful in locating a provider near you.​

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We are not a crisis service and cannot respond to immediate needs for support. If you are in urgent need of mental health support, we encourage you to reach out to your local crisis line. Click here to google search a crisis line near you.​​​​