The Nightingale Counsellor/Client Matching Program - Nightingale Counselling and Research

Welcome.

We're going to ask you a short series of questions. Your answers will help us to find a Counsellor who is an excellent fit for you.

You may be filling this out on behalf of a partner, or family member, or child. We'll ask for your information up top.

Let's begin.

Let's start with your email.

What should we call you?

First

Last

How old are you?

Please let us know how to reach you by phone.

What type of counselling are you looking for?

For me
For my child/youth
For my partner and me
For my family

What's your partner's name?

First

Last

Please let us know how to reach your partner by email?

Please let us know how to reach your partner by phone.

What's your child's name?

First

Last

How old is your child?

Please let us know how to reach your child by email?

If applicable.

Please let us know how to reach your child by phone.

If applicable.

We know that families are complex. After you fill out and submit this questionnaire, someone from our Administrative team will be in contact with you to get all the details.

Where are you located?

Province?

Are you now experiencing symptoms of a severe disorder that has changed and limited your capacity to perceive and respond to ordinary daily life experiences? This includes such experiences as hallucination, delusions, extreme mood dominance, inability to understand normal sensory input, etc.

Yes
No

Is the primary reason you are seeking counselling to directly treat these symptoms without the assistance of other medical practitioners?

Yes
No

Please note:

Owing to regulations in your province of residence (Ontario) Nightingale counsellors are unable to see you unless you are also working with another health professional such as a doctor, psychologist, or psychiatrist to address these issues simultaneously.
After submitting your questionnaire, please email our intake team at admin@nightingalecounselling.com to discuss the particulars of a collaborative care plan.
If you wish to see a counsellor exclusive of any other health practitioner, you will need to look for a clinician who is regulated by the College of Registered Psychotherapists of Ontario (CRPO).

What time of the week is best for you?

Weekdays
Weekends

On weekdays, what time of the day works best?

Morning
Afternoon
Evening

On weekends, what time of the day works best?

Morning
Afternoon

How would you like to meet with your Counsellor? You won't be locked into one or the other, but let us know how you would like to meet with your Counsellor on your first session.

In Person
Online

Is there a Counsellor that has been recommended to you or one that you would like work with (you may choose more than 1)? If not, we'll ask a few more questions to help find an excellent match.

Take me to the list of Counsellors.
Ask me some questions that will help to match with me with a Counsellor.

Nightingale's Counsellors

Do you have a preference in how your counsellor identifies?

Female
Male
Non-binary
No preference

All of the Counsellors at Nightingale are allies to the LGBTIQA+ communities. But let us know if it Is it important that your Counsellor identifies as LGBTIQA+?

Yes
No

Main issues?

One last one before you submit: is there anything else you'd like us to know?

Welcome. We're going to ask you a short series of questions. Your answers will help us to find a Counsellor who is an excellent fit for you. You may be filling this out on behalf of a partner, or family member, or child. We'll ask for your information up top. Let's begin.

We know that families are complex. After you fill out and submit this questionnaire, someone from our Administrative team will be in contact with you to get all the details.

Please note:

Owing to regulations in your province of residence (Ontario) Nightingale counsellors are unable to see you unless you are also working with another health professional such as a doctor, psychologist, or psychiatrist to address these issues simultaneously.

After submitting your questionnaire, please email our intake team at admin@nightingalecounselling.com to discuss the particulars of a collaborative care plan.

If you wish to see a counsellor exclusive of any other health practitioner, you will need to look for a clinician who is regulated by the College of Registered Psychotherapists of Ontario (CRPO).

Welcome.

We're going to ask you a short series of questions. Your answers will help us to find a Counsellor who is an excellent fit for you.

You may be filling this out on behalf of a partner, or family member, or child. We'll ask for your information up top.

Let's begin.