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Intake form

Help us match you to the right therapist

It just takes a few short minutes to give our Mental Health Concierge the necessary info to match you with a suitable mental health expert.

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Who is this therapy for?

Who is this therapy for?*
Next Name

What is your name and age?

Next Child or Contact*

Parent or Guardian?

Next Child*

What is your child's name and age?

Next Child Contact*

Child's contacts?

Next Contact

How do we contact you?

Next Concerns

What are your concerns or issues?

Next Help

How can we help?

How can we help?*
Next therapy

Therapy with

Therapy with*
Next meet

How would you like to meet?

How would you like to meet?*
Next Else

Anything else we should know?

Three Story Clinic

301-601 W Broadway

Vancouver, BC V5Z 4C2

  • About
  • Our Team
  • Pricing & FAQ
  • Who and How We Help

Copyright © 2023 Three Story Clinic | Three Story Clinic is located on the shared, unceded territories of the Musqueam, Squamish, and Tsleil-Waututh First Nations.