New Clients Intake Form

As a Registered Psychotherapist, I am required to have certain information about you on file as per the regulating body The College of Regulated Psychotherapists.. This information is held securely in my clinical records adhering to the regulations set out in the Personal Health Information Protection Act of Ontario and the Electronic Personal Health Information Protection Act.

*Please complete this form and submit through it to me through this website, 24 hours in advance of our next scheduled session.

Name *
Name
I consent to psychotherapy treatment with Ann LeBlanc *
I have read, understand and agree to the policies described on this website *