Request an Appointment

Fill out the following form to request an appointment. Fields marked with * are required.

1. Name*
2. E-mail*
3. Phone
4. Preferred appointment time (Select all that apply)
5. Mornings Afternoons Evenings
6. Preferred day for appointment (Select all that apply)
7. Any day Tuesday Thursday Saturday
   Monday Wednesday Friday Sunday
8. Which program or type of therapy are you interested in? Individual psychotherapy - in office Individual psychotherapy - online or phone Group therapy - MBCT (Mindfulness-Based Cognitive Therapy) Group therapy - Online MBCT (Mindfulness-Based Cognitive Therapy) Group therapy - MB-EAT (Mindfulness-Based Eating Awareness Training) Group therapy - Dialectical Behaviour Therapy Group Other *
9. How can we help you?*
10. How did you find out about us?*
11. Would you like to receive information about upcoming groups or events at The Mindfulness Clinic?
12. Mailing List
13. Yes, please
    No, thank you

 

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© 2012 The Mindfulness Clinic  

416-847-7118
1-866-848-7118

info@themindfulnessclinic.ca
700 Bay Street, Suite 2200 Toronto, Ontario M5G 1Z6