Join Our Wait List

This form is for waitlist requests only. If you're in crisis or need immediate support, please reach out any time to 911, the Suicide Crisis Helpline at 988 (call or text), or the Nova Scotia Provincial Crisis Line at 1-888-429-8167.

Name

First

Last

Phone

Please enter the first name of your therapist:

If to Signature

Please select the type of appointment you would like to be waitlisted for:

In Person
Virtual
Either in-person and virtual

Are you interested in being placed on the ongoing waitlist for future appointment opportunities, or would you only like to be considered for an earlier opening related to your currently scheduled appointment?

Current appointment only
Ongoing

I consent to being contacted by phone call and text message if an appointment becomes available. I understand that I will have 15 minutes from the time of contact to accept the appointment. If I do not respond within that timeframe, the appointment may be offered to the next individual on the waitlist.

Yes, I understand

I understand that if I do not respond to the phone call or text message within the allotted timeframe, my currently scheduled appointment will remain unchanged.

Yes, I understand

Signature

Clear Signature

Please provide any scheduling preferences or restrictions that would be helpful for our team to know (e.g., unavailable on certain days, preferred appointment times, or other availability limitations).

Once you submit, our intake team will personally review your request and reach out by phone or email. We look forward to connecting with you.

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