Name *

First Name

Last Name

Phone *

(###)

###

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What services are you interested in? *

Individual Psychotherapy

Marriage & Couples Therapy

Family Therapy

Screener Tests

Clinical Supervision

Peer Supervision

Preferred Psychotherapist(s) *

You can choose to book a consultation with more than one.

No Preference

Any Female Psychotherapist

Any Male Psychotherapist

Adnan Zoubi, MA, RP

Bolour Kalibar, MA, RP

Cydney Lebovitz-Hoffman, MPsy, RP

Dr. Daniel Rochman, R.Psych., PhD (Alberta Residents Only)

Jeff Driscoll, MPsy, MPsy, RP (Qualifying) - 3 Month Waitlist

Lara da Silveira, MA, RP (Qualifying)

Oren Ogniewicz, MPsy, RP (Qualifying)

Preferred Language of Services *

English

Farsi

Hindi

Portuguese

Spanish

Urdu

I consent for the Centre for Psychodynamic Insights to contact me through phone and email, and leave a voice message. *

Yes

I understand that all sessions are conducted virtually only over video call or phone calls based on your preference. *

Yes

I have checked the session rates and have sufficient insurance coverage or personal funds for potential future sessions, and understand that, like most psychotherapy clinics, we do not offer direct billing due to the absence of a reliable billing system to do so. *

Yes