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Child In Mind - Therapy Waitlist
Thank you for adding yourself to the Therapy Waitlist for Child In Mind. Our team is constantly growing and we will be in touch as soon as we have a clinician available to support you. We thank you for your patience!
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* Indicates required question
Parent(s) Name(s)
*
Your answer
Child(s) Name(s)
*
Your answer
Type of Therapy
*
Child Therapy
Parent Support
Family Therapy
Divorce Support
Other:
Child/Teen's Age
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Brief Description of your needs
*
Your answer
Custody Status
*
Matheson Psychology requires consent from all guardians prior to provided services to a child/teen unless there is a Court Order indicated otherwise. Documentation will be required on file.
Guardians are married, live in the same home, and share custody
Guardians are separated/divorced and share custody **We require consent of both guardians prior to providing services to a child/decision making authority
Guardians are separated/divorced; Sole Decision Making Authority awarded to one guardian **We require a court order indicating Sole Decision Making Authority
My child, myself, and my family are residents of Ontario
*
**We are only able to provide services to residents of Ontario due to Provincial Restrictions**
Yes
No
Referred by
*
Physician
School/Teacher
Friend
Community Agency (CHEO, Crossroads)
Mental Health Professional
Word of Mouth
Google Search
Other:
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