Please provide first and last name
Please provide an email address for email confirmation.
Parent One - Primary Contact information will be used
Please indicate, as this impacts which counsellor you will be assigned to.
(Please note that fees are assessed on your gross annual income. We will require you to show proof of income at your first appointment either by paystubs or annual tax return)
Please note: We must have copies of the child custody arrangements before we can see your child.
(select all that apply)
This question refers to the ethnic or cultural origins of a person’s ancestry, who we identify as, or what environment we are from.
This question refers to how your child has been raised, based on the moral/social principles we use to govern our lives, and how we view the world.