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TherapyWorks Neurodiversity Services & Counselling Associates New Client Inquiry Form

Thank you for your interest in services from TherapyWorks.  If you are seeking an appointment, you have the option of reaching out to our reception desk during operating hours, or completing the information below at a time convenient to you.   

 

Any information you enter below is encrypted and our admin team is notified of your request for an appointment.  

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I am seeking services for: (choose all that apply)
I am seeking: (Select all that apply) Required

We are able to direct bill many extended health insurance providers or third party funders.  If you would like a third party funder or insurance to be direct billed, please contact us to confirm eligibility with your funder. 

By submitting this form, I agree to a TherapyWorks team member contacting me to set up an appointment for the services I have identified above. 

Thanks for submitting!

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