Create Wellness with Art Therapy.
Welcome to the Art of Therapy Counseling Services Sign- Up/Referral form. We thank you for taking time to answer brief questions for more info after this short form @artoftherapy.ca 

If you have an immediate safety concern, please call: 9-1-1, your local crisis line, or the national crisis line at 1-800-273-8255.
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Hello! Please leave your Email and Phone number *
Name of the person completing this form is
Please select who will be receiving the service (Please be aware that Art of Therapy Counseling will require signatures from all guardians with medical decision-making of a minor in order to begin counseling services with a child under 13.)  Select all that apply.
Please give a brief description of your reason for reaching out today
Is the person who will be receiving services located in Ontario, check all that apply.
If completing on behalf of someone else: Is the person, for whom the service is intended, aware that a referral is being made for counseling services?
What is the best way to reach you? Email, Phone call, etc.
*If you are referring on behalf of someone else: what is the best way to reach the client/primary guardian)?
Please let me know how you found out about Art of Therapy Services
Please note that Catherine Galbraith R.P., Dip A.T., B.A. is a private service provider and sessions are  not usually billed directly to insurance. If you would like insurance coverage information, please contact your provider for reimbursement questions for services. You may review session fees and faq after this form at artoftherpy.ca. 
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