New clients

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Tell us a little about what you're looking for, and we'll help connect you with the right service.

About You

Full name

Preferred name(optional)

Pronouns(optional)

Date of birth

Phone number

Preferred method of contact

What You're Looking For

Who are services for?

What service are you looking for?

What would you like support with?

Availability & Format

Preferred format

Preferred clinician(optional)

General availability(optional)

Select all that apply

Insurance & Funding

Do you have insurance coverage for psychological services?

Will you be using any other funding for services?(optional)

One Last Thing

How did you hear about Inclusive Psychology Space?

Anything else you'd like us to know?(optional)

I understand that submitting this form does not establish a psychologist-client relationship and that Inclusive Psychology Space may contact me regarding my inquiry.

Submitting this form does not establish a psychologist-client relationship. We will be in touch to discuss next steps and answer any questions you may have.