Email Form

If seeking a quote, please ensure you have provided a phone number for us to call you back as we cannot provide a quote over email.

fields with * are required. "Submit" button appears at bottom of form.
Name *
Name
OPTIONAL Information
Phone
Phone
Administrative hours are 9 am to 5 pm Mon to Fri. (Clinical hours vary)
Remaining OPTIONAL information may help us provide a quote or referral if you are seeking therapy or assessment from us for the first time. We will still need to call you back to discuss.
Are you a WSIB claimant?
Are you seeking services related to a car accident?
Is this for court purposes?
(If so we may require a court order)
Name of Referring party (if any)
Name of Referring party (if any)