Please fill out this short questionnaire to provide some general and anonymous background about you and the issues you'd like to deal with in therapy. It would help us match you with the most suitable therapist for you. Your answers will also give this counsellor a good starting point in getting to know you. 

NOTE: If you have submitted a request before, please do not resubmit. Email instead, thank you!
Email *
Hello! What is your first name? *
I would like to connect with... *
Please let us know if you have a specific therapist in mind. Please note that some therapists listed may have a full caseload and are not currently accepting new clients (Kim Fisel, Jen Marinas and Kelly Chan are currently not accepting new clients; Danica has left the country; Allison is only conducting virtual sessions at the moment). This list is regularly updated.
Which type of mental health professional are you looking for? *
At A Space Between, we have a range of mental health professionals available to assist you. By selecting the right mental health provider, you can take charge of any challenges in your life and move towards improved well-being."
What is your contact number? *
How many therapists would you like to speak with? *
Please select a preferred number of therapists to be shortlisted for you to speak with. We understand that having too many options can be overwhelming for some clients. Rest assured that your chosen number will be respected, and please ensure you provide accurate contact information for further communication.
What type of counselling are you looking for? *
Would you prefer your regular therapy sessions to be held online or in-person? *
How old are you? *
(Age of the individual receiving treatment - if your child is the one receiving treatment, please indicate their age)
What is your gender? *
What are your pronouns? *
How do you identify? *
Would you like to be matched with a therapist who specialises in LGBTQIA+ issues? *
If English is not your main language, what language would you prefer the session to be conducted in? *
Are there specific concerns you would like to discuss with your therapist? *
(Select all that apply.)
Have you ever been in therapy or counselling before? *
Why are you seeking therapy at this time? *
I prefer a/an... *
Select all that apply
Does the sex or gender of your therapist matter? *
Do you consider yourself to be religious? *
Does the religion of your therapist matter? *
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