Request an appointment This form will help us assign you to the right therapist according to your needs and availabilities. Please note that this process may take from 2 weeks, up to 12 weeks depending on our openings at that time. If you have any questions about our waitlist, please email us at firstname.lastname@example.org Name* First Last Email* Phone*Which of our clinic services are you interested in?*- select an option -Individual TherapyCouple's TherapyTherapy for a child or teenIndividual Mindfulness TrainingOther Individual Wellness ServicesHow can we help?*In which language(s) would you like to receive services?* English French You can select more than one Submit This iframe contains the logic required to handle Ajax powered Gravity Forms.