Match With A Therapist Name * First Name Last Name Email * *We ask that all clients opt in to our emails to receive updates about the practice. Please check the box below. Phone (###) ### #### Child(ren) Name(s) & Age(s) What services are you interested in? Select all that apply. * Therapy (child therapy, family therapy, and/or parent coaching) Psychoeducational Testing Occupational Therapy Intensive Support Program Workshops I'm not sure We are here to help. Tell us a bit about what you are struggling with. * Are there any particular types of therapy you are interested in? Has there been a divorce or separation in the family? * Yes, previously Yes, currently No Are you interested in lower cost therapy options with an MSW placement student? Yes No Do you prefer virtual, in-person or hybrid sessions? Virtual In-person Hybrid No preference For in-person sessions, what location do you prefer? 96 Vine Avenue 2150 Bloor St W Either Are there any times that do NOT work for you to have a session? Please select your preferred language. English French Spanish Mandarin Cantonese Do you have private insurance? Yes No If yes, which professional providers are covered under your insurance? Check your insurance for the registration title (e.g. psychotherapist, not descriptive terms like psychotherapy). Registered Psychotherapist Social Worker - RSW or MSW Social Worker - MSW only Provisionally Licensed Occupational Therapist Psychological Testing I'm not sure How did you hear about us / Who referred you? * Thank you! Our Client Care Coordinator will be in touch with you shortly. You can reach out to us at any time at info@attunedfamilies.com or 416-766-3000.
