514-542-6888 info@psysante.com

 

Thank you for your interest to be a client of Stephane & Clinique PsySanté.


At Clinique PsySanté, all our practitioners are highly skilled and work with a customized intervention plan for you. To best serve you, we invite you fill out an assessment questionnaire. Please complete the appointment request form below to make your initial appointment request. After receiving your information, we will send you an email with the link to your assessment questionnaire. 
Once you fill out your Assessment Questionnaire to your best capacity and click on the “Submit” button, please send us an email at info@psysante.com to inform us. Then, your information will be carefully reviewed by the clinical director and you will be assigned to the right practitioner that will best match your needs. We will then contact you by email or phone to set up your initial assessment appointment. Please allow us 2-4 business days to review your file and contact you. We look forward to connecting with you!

 

Please note that all your information will remain strictly confidential. 

Appointment Request Form

Name:
Email:
Phone:
Age: 
Gender:

Type of service you wish to consult for:

Description of your current situation:

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Alternatively, you may also follow the next steps to fill out your assessment questionnaire as a pdf fillable file or print it out:

1. Click on the questionnaire below that best suits your situation.

2. Save the questionnaire on your Desktop and close the questionnaire on your browser.

3. Go to the questionnaire on your Desktop and start filling it out. The questionnaires are fillable PDFs so you can fill them out online

4. Make sure all the information you enter is saved. Save your filled-out questionnaire as YourName.pdf 

5. Email the saved PDF Questionnaire on your Desktop to info@psysante.com

Note: You may also print the questionnaire, scan, and send it to info@psysante.com OR fax it to 514-542-6889. It is also possible to bring your questionnaire directly to the clinic (12047 Boul. Gouin Ouest) or come directly to the clinic to fill it out there.

Thank you!

Stéphane