Info sheet for registering at the Argyle

Given Name:
Family name:
Your Email:
Street Address: Apt. City:
Province: Postal Code:
Home #:
Work #:
Cell #:
(***Please use this format for phone numbers: 555-555-5555)
Date of Birth:
Year*:
Month*:  
Day*:      
Age:
Occupation:
Therapy:
Language:
Referral:
Sentence describing your main issue:

Days & times during the week that you're available for an appointment:

Spam protection:


Important

Please note that it will take a few minutes to complete this form. If you would prefer to register with the Argyle over the phone, call us at 514 931-5629 ext. 1. All data below will be treated in the strictest confidence and is encrypted by ssl for security. Upon submission of this form, you will receive a confirmation e-mail.

Once you have completed and submitted the form below:

  • our intake worker will contact you by telephone within 72 hours to finalize your registration.
  • Please note that upon being contacted by the intake worker, you will be asked for payment details and charged a non-reimbursable one time fee of $40.00 ($30.00 if unemployed) that covers the administrative costs for opening your file.

The Argyle Institute will discuss payment options for therapy at your first meeting. We offer very affordable rates.

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