Name
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First Name
Last Name
Phone
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Email
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Dr. Amy Wendell is currently taking a waitlist. Please indicate.
Appointment Availability
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Appointment type:
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Are you looking to use insurance?
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Briefly describe what we can help you with? What symptoms or problems are you experiencing?
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How long has this been going on?
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What inspired you to reach out?
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What are you hoping to gain from counselling?
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With which counsellor do you ideally want to meet?
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Dr. Amy Wendell, Psy. D.
Megan Secord, B.A., MACP, CCC
If you've received counselling before, was it helpful? Please briefly describe what you appreciated about your counsellor or the counselling process. If it was not helpful, please briefly describe what you didn't like.
How did you find us?
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Referral
Psychology Today
Online Search
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A friend/word of mouth
Flyer around town
What counsellor qualities are you seeking? Select all that apply.
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Thank you for taking this important step toward your personal growth.
We look forward to connecting with you!
