Contact Questionnaire

Thank you for taking the time to fill out this questionnaire. You will be contacted within 24-48 hours to set up a free consultation! You are not committed to anything by filling out this form. Filling out this form does not create a therapeutic relationship.

First point of contact will by by e-mail.

First name

Last name

Email

What Province Are you Located in?

At this time, in-person appointments in Nelson, BC are only available on Thursdays. There is potential for other days in-person, so please let me know your best days and we'll see what we can make work! Virtual appointments are available Mon-Sat.

Are you looking for services for yourself or your child?

Myself

Child

Teen

Is there anything else that you would like for me to know at this time?