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Individual & Couples Intake Salesforce
Language
  • English (Canada)
  • 1
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  • 2
    For clients 16 years or younger, Layla requires consent of parent or guardian
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  • 3
    • ADHD (strategies to manage)
    • Aging
    • Anger management
    • Anxiety (incl. panic, GAD, and social)
    • Behavioral Addiction
    • BPD or related symptoms
    • Coping with chronic pain or illness
    • Coping with concussion or ABI
    • Court-mandated
    • Eating disorder
    • Emotional eating/other eating challenges
    • Emotion regulation
    • Depression, sadness, or low mood
    • Dissociation
    • Family conflict
    • Fertility Issues
    • Grief or loss
    • Impacts of racism or discrimination
    • Imposter Syndrome
    • Immigration-related life challenges
    • Life transitions/uncertainty
    • OCD-related symptoms
    • Personality disorder other than BPD
    • Phobia(s)
    • Pre- or Post-Natal challenges
    • Psychosis
    • Relationship challenges
    • Intimate partner abuse
    • Self-esteem
    • Self-exploration
    • Sexual abuse/assault (including childhood sexual abuse)
    • Sexual or gender identity
    • Sexual dysfunction
    • Skin-picking or hair-pulling
    • Sleep concerns
    • Stress/burnout
    • Substance use or addiction
    • Trauma (single-incident)
    • Trauma (multiple incident or ongoing)
    • Work or school issues
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  • 4
    • Improve Communication
    • Conflict Resolution
    • Parenting Skills
    • Problem Solving
    • More intimacy (emotional)
    • More intimacy (sexual)
    • More quality time together
    • Amicable separation
    • Resolve individual issues
    • More autonomy
    • More respect/understanding
    • Power and control issues
    • More hobbies
    • More social contracts
    • More sharing of the chores
    • Help for children's behaviour
    • Court-mandated
    • Other
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    Select all that apply
    • ADHD (strategies to manage)
    • Aging
    • Anger management
    • Anxiety (incl. panic, GAD, and social)
    • Behavioral Addiction
    • BPD or related symptoms
    • Coping with chronic pain or illness
    • Coping with concussion or ABI
    • Court-mandated
    • Eating disorder
    • Emotional eating/other eating challenges
    • Emotion regulation
    • Depression, sadness, or low mood
    • Dissociation
    • Family conflict
    • Fertility Issues
    • Grief or loss
    • Impacts of racism or discrimination
    • Imposter Syndrome
    • Immigration-related life challenges
    • Life transitions/uncertainty
    • OCD-related symptoms
    • Personality disorder other than BPD
    • Phobia(s)
    • Pre- or Post-Natal challenges
    • Psychosis
    • Relationship challenges
    • Intimate partner abuse
    • Self-esteem
    • Self-exploration
    • Sexual or gender identity
    • Sexual dysfunction
    • Skin-picking or hair-pulling
    • Sleep concerns
    • Stress/burnout
    • Substance use or addiction
    • Trauma (single-incident)
    • Trauma (multiple incident or ongoing)
    • Work or school issues
    • Other
    • Attachment Disorders
    • Parenting
    • Perfectionism
    • School-related anxiety/Avoidance
    • Sport-related / Athletes
    • Women's Issues (Hormonal)
    • Young Adult
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    • Improve Communication
    • Conflict Resolution
    • Parenting Skills
    • Problem Solving
    • More intimacy (emotional)
    • More intimacy (sexual)
    • More quality time together
    • Amicable separation
    • Resolve individual issues
    • More autonomy
    • More respect/understanding
    • Power and control issues
    • More hobbies
    • More social contracts
    • More sharing of the chores
    • Help for children's behaviour
    • Court-mandated
    • Other
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    Skip if not applicable
    • Adjustment disorder
    • Agoraphobia
    • Anorexia Nervosa
    • Antisocial personality disorder
    • Anxiety (Unspecified)
    • Any diagnosis related to neglect/abuse
    • Any Psychotic disorder
    • Any Sexual Disorder
    • Any Sleep Disorder (Incl. Insomnia)
    • Any Substance Use Disorder
    • Attention-deficit/hyperactivity disorder
    • Autism spectrum disorder
    • Binge-eating disorder
    • Bipolar Disorder (Type I or II)
    • Body dysmorphic disorder
    • Borderline Personality Disorder
    • Bulimia Nervosa
    • Conduct disorder
    • Delusional disorder
    • Depression (Unspecified)
    • Dissociative identity disorder
    • Enuresis
    • Gambling disorder
    • Gender dysphoria
    • Generalized Anxiety
    • Hoarding disorder
    • Health anxiety
    • Intellectual disability
    • Intermittent explosive disorder
    • Kleptomania
    • Major Depressive Disorder
    • Narcissistic personality disorder
    • OCD
    • Oppositional defiant disorder
    • Overweight or obesity
    • Panic Disorder/Panic attacks
    • PDD (dysthymia)
    • Premenstrual dysphoric disorder
    • PTSD
    • Pyromania
    • Reactive attachment disorder
    • Separation anxiety disorder
    • Skin-Picking or Hair-Pulling
    • Social Anxiety
    • Specific learning disorder
    • Specific phobia
    • Tourette’s disorder
    • Unspecified personality disorder
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  • 17
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  • 18
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  • 19
    Select all that apply
    • Single
    • Dating
    • Living together
    • Common law
    • Married
    • Divorced
    • Separated
    • Living apart
    • Widowed
    • Not sure
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  • 20
    0 being poor and 10 being exceptional
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  • 21
    Select all that apply
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  • 22
    Select all that apply
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  • 23
    Briefly elaborate on the nature of the problem (e.g. substance, reason for concern, etc.). Skip if not applicable
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    If so, in what way?
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    If so, in what way?
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  • 26
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  • 27
    0 being poor and 10 being exceptional
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  • 28
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  • 29
    Generally, couples counselling begins weekly or bi-weekly and may taper down, but it depends on the therapist and clients’ specific case
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    Skip if not, or not sure
    • CBT-Informed
    • CBT-Structured
    • DBT-Informed
    • DBT-Structured
    • EMDR
    • EFT
    • Mindfulness
    • Psychodynamic
    • Anti-Oppressive Practice
    • Short-Term Solution-Focused
    • Narrative Therapy
    • Somatic
    • Hypnotherapy
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  • 33
    For example: from a certain minority community, identifies as a certain gender, understands a culture, speaks a certain language
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  • 34
    If you or someone you know is in crisis or at risk of serious harm towards yourself or others, call 911 or go to an emergency room
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  • 35
    Layla's individual and couples counselling is only available to Ontario residents at this time. Note: Layla's partner therapists are mostly remote for the time being. If you're looking for in-person sessions, we can connect you to a therapist with a convenient location and in the interim, offer you to start with secure video or phone sessions with the same therapist. .
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    Our in-person therapists are location across GTA and surrounding areas. Go back to choose remote only options
    • Toronto - East End (E of Sherbourne)
    • Toronto - West End (W of Bathurst)
    • Toronto - Midtown (N of Davenport)
    • Toronto - Downtown (S of Davenport)
    • Toronto - North West
    • Etobicoke
    • North York
    • Scarborough (E of Victoria Park)
    • Durham Region
    • Halton Region
    • Peel Region
    • Hamilton
    • Markham
    • Richmond Hill
    • Newmarket
    • Vaughan (includes Woodbridge)
    • Kitchener/Waterloo/Guelph
    • Barrie
    • Ottawa
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    All our therapists are licensed to conduct Psychotherapy in their jurisdiction. We do not currently work with Psychologists.
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  • 42
    Please write your full name below. If you're a parent/guardian seeking support for a child, enter child's name.
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  • 45
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  • 46
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  • 47
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  • 48
    By providing us with your partner's email they consent to receiving communications from the Layla Care team.
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  • 49
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  • 50
    If you select In-Person preference this address will be used as an anchor to optimize for distance to your therapist's office. Layla's individual and couples counselling is only available to Ontario residents.
    Please Select
    • Please Select
    • United States
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curacao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 53
    Pick a Date
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  • 54
    Pick a Date
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  • 55
    Include name(s), relationship to you, contact info (phone, email)
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  • 56
    Provide name and email of person paying for sessions. By providing their name and email below, they consent to being contacted by Layla
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  • 57
    Please provide name, phone, email, and relationship to you
    0/40
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  • 58
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  • 60
    Name and area/region
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  • 61
    Name and area/region
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  • 62
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  • 63
    Layla's individual and couples counselling is only available to Ontario residents at this time. All our therapists are licensed to provide psychotherapy in their jurisdictions through their respective regulatory colleges. Our therapists cannot diagnose or prescribe medication. We have consistent pricing across all of our therapists and for all of our clients and thus cannot offer sliding scale services.
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  • 64
    We respect your right to privacy and follow all regulatory requirements for keeping your personal information private and secure. Limits to this confidentiality include any situation in which there are reasonable grounds for suspicion of harm to a child or serious imminent harm to yourself or others. In these situations, we have a right or obligation to break confidentiality for the safety of the person(s) at risk. For more information please review our complete Privacy Policy on www.layla.care/privacy-policy
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  • 65
    A standard session length is 50 minutes and cost $130 ($170 for couples) including applicable taxes if any. You will be provided with a receipt for insurance. Layla reserves the right to change its prices with reasonable notice. A 24-hour cancellation policy applies. You will be responsible for full payment of appointments missed without 24 hour notice. Exceptions can be reasonably accommodated in the event of an unforeseen serious emergency. If you have 2 outstanding charges without having contacted us to explain why, you will not be able to book additional sessions until payment has been made or planned for.
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  • 66
    Layla's intake call is free. Fees for subsequent therapy sessions apply. Layla's services are not covered by OHIP
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  • 67
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  • 68
    Your therapist is a an independent practitioner contracted to Layla. You acknowledge that Layla Care Inc. itself is not providing treatment or other medical services to you. Layla makes suggested therapist matches to you based on the information provided by you and by them, and does not guarantee their ability to assist you. Therapists contacted to Layla are solely responsible – as independent providers - for the provision of professional health services as they deem appropriate. Any dispute between you and a therapist is strictly between you and such therapist Layla. You agree to indemnify and hold Layla, its directors, officers, employees, agents and shareholders, harmless from any claims, demands, losses, liabilities, and expenses arising in connection with: (i) your use of the Layla’s services, (ii) Healthcare services provided by an independent provider facilitated by Layla; (iii) your violation of any of these terms; or (iii) your violation of the rights of any third party.
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