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Name

First Name

Last Name

Email

Subject

Message

Please state what type of counselling or services (one-on-one, group, contract) you are inquiring about and any other relevant information you believe is helpful. Please do not include personal health information or any other private details. This information can be shared when you are directly contacted. Please indicate in the message box if it is okay to leave a voice message on your phone, or if there is a different email address you would like your reply sent to. If you are inquiring about another person, please state so and whether you have obtained their consent to discuss this matter and book an appointment for them or to speak about them. We can still speak if they have not, however, we will have to refrain from using their name or other identifiable information. Thank you.

Prior Consult Attended

YES

No

Phone

(###)

###

####

Please ensure your email address and other contact information is correct before submitting. Because technology is not without issue, if you have not heard a response within 24 hours, please email contact@sarahwarrycounselling.com

60 minute sessions are $120 and are not covered by private insurance or OHIP.

Please fill out your private intake and consent document here : CONSENT and INTAKE