Please complete the form below to request a first appointment. We use this information so that we can best match you with a therapist who best meets your needs.
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    Contact Information
    *First Name:
    *Last Name:
    Street Address :
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    *For reasons of confidentiality, please advise us if we can contact you and/or leave a message at the number you have provided.
    Language : Please indicate which language (s) you would feel comfortable with for therapy

    If "Other" please specify:
    Request for
    Many of our therapists are now offering online therapy and phone sessions.
    Are you open to meeting with your therapist online?
    *During this period of social distancing, many of our therapists are offering online rather than in-person sessions.
    What is your availability for scheduling sessions?
    Please indicate all times during which you are available for scheduling. Be as specific as possible. Eg. Mondays: morning, afternoon, evening, etc:
    Date of birth (DD-MM-YYYY )

    Therapy Fees(subject to applicable taxes)*
    Request for:

    Gross family income ( your pre-tax household income )
    This will be used to calculate your fees based on our sliding scale

    *Are you covered by an Insurance plan? Please verify the details of your plan since some companies only cover specific types of professionals or services
    Marital Status
    Please tell us who referred you
    *Presenting issues   Check all that apply
    AddictionAcademicAnger ManagementAnxietyCareer/Work RelatedDepressionEatingGriefInterpersonalPhysical IllnessRelationship-FamilyRelationship-CoupleRelationship-Family of OriginSelf-EsteemSexualSexual DysfunctionSexual OrientationStress

    Please provide a brief description of the current presenting issue and any other information to help us match you with a suitable professional:
    Do you have a preference as to the gender of your therapist?
    Would you prefer that your therapist contact you by:


    Diana R.
    Individual Therapy

    A good (great) therapist like mine is kind, compassionate- does not judge you but will be honest and true and challenge you to take steps out of your comfort zone to show yourself what you are really capable of.
    Therapy has been an amazing gift for me.

    Jane P.
    Group Therapy

    Sharing with a group of people brought another dimension to the journey, with deep feelings of belonging, togetherness, safety, freedom.

    Jonathan R.
    Couples Therapy

    The services of the MTC have helped my wife and I keep a balance at home and we have grown as a couple tremendously. We would definitely recommend the MTC again and again.

    Pierre G.
    Art Therapy

    I didn’t see myself as the “creative art” kind of guy. Now, I think everyone can have a creative space inside, just need to try and find your medium(s).