Contact - Excellence in Psychotherapy

613 – 404 – 5004

ADMIN@OTTAWATHERAPYGROUP.CA

FULL NAME (*)

PHONE NUMBER (*)

EMAIL (*)

SERVICES REQUESTED (*)

AVAILABILITY

In-Office Only

Online only

Online and In-Office

TREATMENT LANGUAGE

PREFERRED THERAPIST

PREFERRED DAY AND TIME (NOT GUARANTEED)

DATE OF BIRTH (*)

PLEASE DESCRIBE WHY YOU ARE SEEKING SERVICES:

(*)

By checking this box I hereby authorized the Ottawa Therapy Group to communicate with me via the means provided above regarding the services I am requesting. I also understand that the Ottawa Therapy Group does NOT use email addresses or any other electronic addresses for commercial/promotional purposes as understood by Canada's Anti-Spam Legislation (CASL)

(*)

By checking this box I understand that the Ottawa Therapy Group cannot guarantee the security and confidentiality of information sent through this contact form. You can also request services by calling the Ottawa Therapy Group at 613-404-5004.

If you are experiencing an emergency situation, you can call the Mental Health Crisis Line (bilingual) 24 hr service 613-722-6914 * Toll free 1-866-996-0991 or present yourself at the nearest emergency room or call 911.