New Client Interest Form

✨Thank you so much for your interest in counselling sessions with Dania Chebib at Divergent Psychotherapy!

While Dania is not maintaining a formal waitlist, we warmly welcome you to join her Interest Form. This helps us in admin reach out to potential new clients with care and intention when an opening becomes available.

We truly appreciate you taking the time to share your details below.

All responses will remain completely confidential. Please keep in mind that communications over the internet are not always secure, though we will make every effort to ensure the information provided on this form is protected.

If you have any questions, please let us know.

Warmly, 
Divergent Psychotherapy's Admin Team
Are you a new or an existing client? *
First Name *
Preferred Name *
Last Name *
Pronouns *
Email *
Cell Phone Number *
Do you currently reside in British Columbia? *
Please note: Dania is currently licensed to practice in the province of British Columbia, Canada.
Are you 19 years old or above? *
Please note: Dania currently works with adults ages 19 and above.

If you are 18 or below, please send us an email as we would be happy to provide you with referral options.
Email: info@divergentpsychotherapy.ca
Session fees. Please confirm if you're able pay these fees. *
Dania Chebib's rates are as follows:

Individual Counselling

* $225 for a 50 minute session
* $337 for 75 minute session

Unfortunately all sliding scale spots have been filled. You may be eligible for reimbursement if you have extended benefits, but we do not do direct billing.
Are you able to commit to a regular time slot (available for sessions at the same time each week/2 weeks)? *
A quick note: to confirm a spot with her, Dania does require that you are available for recurring appointment at a weekly or biweekly frequency for the first little while. We know this doesn't always work out if your work schedule isn't fixed, so we just want to mention it now before you complete the form.

Additionally: in order for therapy to be effective, consistency is important. It is encouraged to be available to commit to at least once every two weeks frequency of therapy, especially at the beginning. Weekly therapy may also be advised, depending on your therapeutic goals. You and your therapist will discuss this at your first session :)
What days of the week are you available?
Select all that apply.
 *
Required
What time of day are you available?
Select all that apply. *
Required
Briefly describe your concern that you wish to address in therapy. *
If you are needing a referral, a brief concern allows us to send you suitable alternatives for counsellors that may fit your needs.
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