Service Request

Please complete this questionnaire to request psychotherapy, sex therapy, psychological or neuropsychological assessment services.

Please note that your request could be added to a waiting list depending on the problem and the availability of our professionals.

When availability becomes available, a receptionist will contact you to schedule a first appointment.

Warning: if your browser has automatically filled in the first and last name fields, make sure that it is those of the person to whom the services will be offered.
This information will be used by a receptionist to select a professional for the consultation.
Please note: keep in mind that our fees are tax-free and are repayable, in whole or in part, by various insurance plans. However, we strongly advise you to consult your insurance plan to understand the inclusions and exclusions of your coverage. Regardless of your coverage, however, you must pay after each session. A receipt will then be issued which will allow you to claim a refund from your insurance company. Please note that we need a letter from your employer/payer in which he confirms that he will pay.
Please note that if your employer will pay the fees for your psychological services, we will need a letter confirming that he will pay, and other financial details (eg: maximum number of session, maximum budget).
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Send service request
Click on the Submit button to send your request.
Warning: you will not be able to change your request afterward.