Intake Form | Core Connections Psychology

How do you prefer to be contacted? Required

email

phone

phone and email

What services are you interested in? Required

What location are you seeking services in? Required

Collingwood (in person)

Newmarket (in person)

Virtual only

hybrid of vitual/in person

What are your preferred appointment times? Required

weekday mornings

weekday afternoons

weekday evenings

weekends

Please indicate if you are looking for a certain treatment approach?

Are you expereincing any of the following?

Substance abuse or addictions issues

psychosis or mania

eating disorder (binging, restriciting, over eating)

suicidal thoughts

suicide attempts in the last year

self harm behaviours (cutting, burning, high risk activities)

history of trauma

Abuse in a primary relationship

Choice 1

Online Intake Form