Discovery Form Your Name (required) Your work or daytime phone (required) Your home or evening phone Your best email (required) Address Date of Birth Gender: MaleGender: FemaleGender: Other Relationship status In committed relationshipNot in a relationshipIt's Complicated If children, please list ages Occupation - what do you spend most of your time doing? Hobbies - what do you do for fun? Have you ever been diagnosed with or treated for an emotional problem or mental illness YesNo If YES, please give details How did you hear about us? FriendWorkshopMeetupTurnOnToronto websiteFacebookOther What are you seeking support for? How is this causing a problem or challenge in your life? If you work with us and are totally successful, what will change? What have you already tried? What were the results? Would you prefer to meet in person or via video conference? In PersonVideo Conference
