Home
Services & Specialties
My approach
Location & Contact
Menu
Lasha Shaw-Korchynski
psychotherapy services
Montreal, qc
6139122227
Professional, confidential services with a registered psychotherapist.
REQUEST CONSULTATION
Lasha Shaw-Korchynski
Home
Services & Specialties
My approach
Location & Contact
Subject
REQUEST FOR SERVICES/CONSULTATION
Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Location
*
Ottawa area
Gatineau/Outaouais
Other (please leave a comment below)
Reason(s) for seeking therapy:
*
May I ask, how old are you? (Exact age or approximately)
If desired, please indicate the type of services you are most interested in:
Regular/ongoing therapy (e.g. weekly sessions or similar, short term or long term)
Just an initial session or two.
Meeting occasionally/once in a while, as needed.
I don't know./Something else./It depends./Let's discuss.
If desired, please indicate your general availability:
Monday mornings - video sessions
Monday afternoons - video sessions
Tuesday mornings - video sessions
Tuesday afternoons - in person sessions
Wednesday mornings - video sessions
Wednesday afternoons - in person sessions
It depends./Let's discuss.
If you will be submitting insurance claims, do you have any questions about eligibility?
How did you hear about my services?
Recommendation from a health care provider
Recommendation from friends or family
Online (Google search, Psychology Today or other directories, etc)
Other (please leave a comment below, if you wish to)
If someone recommended my services, please specify the name of the person and your relationship to them.
Is there anything else you would like to add?
Thank you for your message. I respond to most inquiries within one business day.