Intake Form | SoulMaze Art Therapy

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Affordable Online and In-Person Therapy for Individuals, Families and Groups

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Intake Form

First Name

Last Name

Email

Phone

Street Address

City

Region/State/Province

Postal / Zip code

Country

The address is required to participate in online therapy in case of an emergency.

Emergency Contact

Emergency Contact Phone

What Made You interested in this group?

What are some of your concerns that you would like to address?

I already sent e-transfer to soulmaze.arttherapy@gmail.com

Email me at - soulmaze.arttherapy@gmail.com

Online and in-person therapy

Toronto, Vaughan, Richmond Hill, Aurora, Newmarket and surrounding area.

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