Intake form

Help us serve you better

Name *

Email address *

What type of service are you interested in?

Please select at least one option.

Psychotherapy sessions

Group sessions

Wellness coaching

Life coaching

Psycho-education

Corporate training

What is your age group?

What is your primary concern or reason for seeking therapy?

Have you previously received mental health services?

If yes, please specify the type of services received.

How did you hear about WayToTherapy?

Are you currently under any medication for mental health issues?

If yes, please specify the medication.

What days and times are you available for sessions?

Additional questions or comments

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