Appointment Request Form

Profile Information

Please take a moment to fill out our Appointment Request form. We will review your information and get back to you within 3 business days. Because this is not an emergency service, if you are in crisis and require immediate attention please call a distress line (613-722-6914 inside Ottawa; 1-866-996-0991 outside Ottawa), call 9-1-1 or go to the nearest emergency room.

Please note that the information submitted electronically through this form is encrypted in compliance with the Personal Health Information Privacy Act (PHIPA).

MyselfSomebody else


Can we contact you by email if we have any questions? Remember that email is not entirely secure. If you are using your work email please note that your employer may have the right to access your email account.

Adult ADHDAngerAssertivenessBipolarBody DysmorphiaBorderlineChronic/Acute Health ProblemsDepressionEating (Anorexia/Bulimia)Generalized Anxiety (Worry)GriefHealth AnxietyLife TransitionObsessive-Compulsive Disorder(OCD)PainPanic AttackPost-Traumatic Stress Disorder(PTSD)Pregnancy and Postpartum AdjustmentRelationships IssuesSpecific PhobiaSleep (Insomnia)StressSocial AnxietySubstance UseWomen's Health

Family physicianOccupational TherapistPsychiatristSocial WorkerOther

Services Of Interest

Adult ADHD AssessmentAdult ADHD TreatmentCouples TherapyGeneral Diagnostic AssessmentGroup TherapyHome- and Community-Based ProgramIndividual TherapyIntensive Anxiety Outpatient Treatment (OCD and other anxiety disorders)Services provided by studentsTeletherapy (Videoconferencing)Virtual Reality (for phobias and social anxiety)


Monday morningMonday afternoonTuesday morningTuesday afternoonWednesday morningWednesday afternoonThursday morningThursday afternoonFriday morningFriday afternoon