Workshop Intake Form

Name *
Please include your preferred name and your full legal name.
Phone *
Name, Relationship to you & Phone Number
Do you have a history of any of the following? *
Babes in arms are welcome - please indicate if you will be bringing yours!
Confidentiality *
Your confidentiality is taken very seriously and will be respected. No information will be released about you except for in the following circumstances: * If you give consent * If your safety or someone else's safety is in question * If there is reason to believe that a child/minor is at risk of being harmed * If your file is subpoenaed and required by law


Payment is required in advance to secure your booking in groups, workshops & individual sessions. Payment can be made via e-transfer to

Please note that a minimum of 48 hours notice is needed to cancel or reschedule any sessions; if this notice is not given, full payment is still required and will not be refunded. (Exceptions can be made in extenuating circumstances).

Individual/Couples Therapy Session - 1 Hour: $95.00

Individual/Couples Therapy Session - 1.5 Hours: $135

Group Session - 2 Hours: $60

Workshops - Please see price indicated for each individual workshop advertized as prices may vary.