Confidential Screener for Potential Clients

This form is confidential and encrypted. Your form will be deleted if services cannot be provided.

Thank you for your interest in my services and having the courage to take control of your life! As a Registered Psychologist, I can teach you techniques to reduce your depression, anxiety, and stress. In our sessions, you will learn to change thoughts about yourself, your life, and other people, so that life and relationships are much more enjoyable. You will focus more on the present instead of living in the past or worrying about the future. Once these skills become habits, you’ll be spending more time on what’s valuable to you--that’s the key to life fulfillment and purpose. I will provide the safe, non-judgmental space you need to discover your unique self, and find effective treatments for your difficulties or symptoms. I look forward to meeting you soon!

Sincerely, Dr. Candice

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Clients: Adults ages 18 to 65

Therapies: Cognitive-Behavioural Therapy (CBT), CBT for core beliefs, exposure therapy, Acceptance and Commitment Therapy (ACT), mindfulness training, solution-focused brief therapy, relaxation training, Interpersonal Therapy (relationship conflicts, changing roles, communication, grief), problem-solving therapy, behavioural activation, person-centered therapy, and positive psychology.

Appointment Availability: Virtual/Online/Video appointments are available on Mondays, Tuesdays, and Wednesdays from 1:00-7:00 and Saturdays from 1:00-4:30. In-person appointments and free phone consultations are not available.

Appointment Fee: $215 for each 55-minute video session. Online payments with Visa, Mastercard, Visa Debit, or Mastercard Debit are accepted. Direct billing through TELUS eClaims is available for some insurance companies (LIST of INSURERS). Sliding scale is unavailable.

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Completing this form will help me determine if I have the skills, training, and experience to help with your concerns. If we are a good fit, I will contact you to book an appointment. If I do not think I can help you, I will contact you and provide self-referral options if they are available. This form is confidential and it will be deleted if I am unable to help you. Please complete the form below and I will contact you as soon as possible. Thank you!

First Name

Last Name

Phone Number

Email address

For confidentiality, please use your personal email, not a work email

What is your age?

How did you hear about this service?

Psychology Today Online directory Online/Google search Social Media Insurance company Family member Friend or aquaintance A doctor or health professional Other

Please describe other problems, concerns, or symptoms not listed above.

Dr. Bovell does not provide suicide crisis services. If you are in crisis and plan to commit suicide now, please call 988, visit an ER or call one of these Crisis Lines. Treatment is not available for the following concerns: childhood or chronic trauma (i.e., C-PTSD), addictions or substance use, ADHD assessment or treatment, autism spectrum disorders, borderline personality disorder, court-ordered or related treatment, fertility issues, parenting issues, sexuality issues, dating, or wanting a romantic partner. Dr. Bovell may not be a good fit for police, corrections, or military clients.

Type of service wanted Please select all that apply

Individual therapy or counselling

Consultation (1 hour)

Free consultations unavailable

Diagnosis

WSIB Community Mental Health Program (CMHP) assessment and treatment

Please write your claim number, case manager name and phone number, and if you have been approved for an assessment and treatment in the box below.

WSIB CMHP Claim Number, Case Manage Contact, and Approval Information

***Intellectual assessments, police or military fitness assessments, risk assessments, firearm assessments, family therapy, and couple's therapy or counselling are not available.

Are you seeking any of the following? Please select all that apply

Note/form supporting a leave of absence from work?

Notes and forms will only be completed after 2 sessions

Note/form supporting difficulties at school

Notes and forms will only be completed after 2 sessions and intellectual assessments are unavailable

***Notes/forms supporting the use of emotional support animals are not available.

If you have any questions or concerns, please write them here

Dr. Bovell has video appointments available on Mondays, Tuesdays, and Wednesdays from 1:00 to 7:00 and Saturdays from 1:00 to 4:30. Is there a day or time that you prefer?

Monday afternoons

Monday evenings

Tuesday afternoons

Tuesday evenings

Wednesday afternoons

Wednesday evenings

Saturday afternoons

Your information will be encrypted.

Confidential Screener for Potential Clients

This form is confidential and encrypted. Your form will be deleted if services cannot be provided.

This form is confidential and encrypted. Your form will be deleted if services cannot be provided.

Dr. Candice Bovell. Ph.D., C.Psych.

Clinical Psychologist, Wellness View Psychological Services Ontario