First Name *

Last Name *

Phone *

Email *

Who is this for?

Myself

My Child (13+)

Other

Please note that we do not provide services for children under the age of 12.

I'm looking for the following services

Psychotherapy

Group Therapy

Workshop or Speaking Service

Other

Please note that we do not provide Psychoeducational Assessment (including ADHD and Autism Assessments) at the moment. Please note that we do not provide support in legal matters (e.g. civil or criminal court proceedings, becoming involved in employer-employee disputes, union work, etc.), nor do we act as expert witnesses in a court of law.

Type of clinician preference

Psychologue ou Associé de Doctorat

Psychothérapeute Autorisé

Psychothérapeute Authorisé Stagiaire

Je n’ai pas de préférence

How could Uprise Psychology & Wellness help you?

Weekly Availabilty

Monday

Tuesday

Wednesday

Thursday

Friday

Time Availability

Early Morning

Morning

Lunchtime

Afternoon

Evening

Clinician Gender Preference?

Female

Male

No preference

Communication Preference?

Text

Call

Do you have preference for virtual or in-person services?

En personne seulement

Je préfère en personne, mais je pourrais faire une séance virtuelle occasionnelle

Ouverts aux deux

Je préfère les séances virtuelles, mais je pourrais y aller en personne de temps à autre.

Virtuel seulement

How did you hear about us?

Google Search
Psychology Today
Referral from a healthcare professional
Referral from a someone I know
Website
Social Media (Instagram, Facebook, Tiktok)
Other
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