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New Client Screening
This form is used to determine if our clinic is the best option for your needs. If so it will help determine which provider would be the best fit for you. The more information provider the better we will be able to support your needs.
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Email
*
Your email
Name
*
Your answer
Phone Number
*
Your answer
Age of potential client?
*
Your answer
Location
*
Strathmore Area
Stettler Area
Alberta (Looking for virtual options)
What brings you to therapy at this time?
*
Your answer
Have you received therapy or counselling in the past? If so, what was your experience like?
Your answer
What are you looking for in a therapist/counsellor?
Your answer
Do you have insurance coverage for mental health services? Who is your insurer?
Your answer
Do you require us to be able to direct bill your insurer for session fees?
Yes
No
Clear selection
Do you have any financial limitations that may limit your ability to pay fees between $180-220 per session? What are you comfortable paying per session?
Your answer
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