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Sign-up to Speak with a Therapist
This form is to get some general information from you so that our registered psychotherapist can easily schedule you in for a 1 on 1 session. 

Please fill out the form honestly and fully so that we can help you as soon as we are able. 

The information on these forms is private to each individual and is not shared with anyone other than the registered psychotherapist. 

PLEASE DO NOT REGISTER AN EMAIL WITH THE DOMAIN SCDSB.ON.CA (SCHOOL EMAIL). These email addresses are not able to receive emails from our therapist. 

If you have already registered with a scdsb.on.ca email address, please resubmit the form with a new email (gmail.com, outlook.com, hotmail.com, live.ca etc.)

Expect an email or text from Michele Rich, Registered Psychotherapist.  Michele will help you to connect with the right therapist for you.  Remember to check your junk mail.  Michele tries to respond to each request within 48 hours (weekdays).  Michele will help you to connect to the right therapist for you.
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Email *
Are you comfortable sharing your phone number so Michele Rich, RP can text you?  If so, please provide your number below.  Michele will help you connect to the therapist that is right for you.
The reason you have requested a visit (what you would like to talk about)  *
This sections is to pick a time that works best for you*
*Please understand that the time and day that you pick is not a guarantee that you will have an appointment that day. Once the therapist contacts you back and confirms your appointment, is when you will be scheduled. Expect an email or text from Michele Rich, Registered Psychotherapist.  Michele will help you to connect with the right therapist for you.
What days work best for you  *
Required
What time is best for you (between 3pm-7pm) *
Time
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This form was created inside of Elephant Thoughts Educational Outreach.

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