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NEW CLIENT ONLINE APPOINTMENT BOOKING FORM

Your privacy is extremely important.  All information provided is kept strictly confidential.

Meet our therapists or read about us in the media.

This form is for first time / new clients.  If you are an existing client click here

Please check your junk / spam folders if you have not heard back from us within 24hrs – 48hrs.

First Name (required)

Last Name (required)

Your Email (required)

Your Primary Telephone Number (required)

May we leave a confidential message on your primary phone voice mail?: (required)
 Yes No

Date of Birth: (required)

Address (please include unit or suite number) (required)

City (required)

Postal Code (required)

Please describe the one concern that best fits what you are looking for help with?

INSURANCE: Psychotherapy services at Men Therapy Toronto will only be covered if your insurance covers treatment by a Registered Psychotherapist (RP).

 Yes, I understand I'm only covered if my plan covers a Registered Psychotherapist (RP)

FEES: Each 55 minute session costs either $175 or $160 or $140 or $70 dependent on the psychotherapist you work with. All fees are paid by debit or credit card (no cash).

 Yes, I understand the per session fee charges

LATE CANCELLATION POLICY: Men Therapy Toronto charges full session fees ($140) for appointments which are cancelled less than 24hrs before the appointment start time.

 Yes, I understand and accept the late cancellation policy

PSYCHOTHERAPIST: Is there a specific Registered Psychotherapist that you'd like to work with?

Our computer system sends out automated email or text reminders 24hrs before your appointment. How would you like to receive these automated appointment reminders?:

 Email Reminder Text Reminder Both Email & Text Reminder

How did you hear about Men Therapy Toronto? If you did an online search can you kindly indicate what you searched for? Example: Google: 'Sex Addiction Toronto'

May we add your email address to our newsletter list for occasional updates, news and resources regarding men's mental health?

 Yes No, Thank You.