For new clients, please fill out the form below so we can connect you with one of our therapists. *Please note: most of our therapists have limited availability at the moment. 

Primary Contact *
Primary Contact
Contact Number *
Contact Number
Secondary Contact
Secondary Contact
Contact Number
Contact Number
What services are you looking for (please check all that apply) *
(AFU, At Home Program, Variety, CKNW, etc.)
Area(s) of Concern (check all that apply) *
Availability (this section is mandatory and please provide as much information as possible)
What days and times are you available for your desired/ongoing service(s)? Please list your availability using the following format: (e.g., Monday: 9:00 to 12:00, Tuesday: all day, Wednesday: 4:00 to 5:00; 7:00 to 8:00)