Free Therapy Session Waitlist Form

Thank you for your interest in the free one-time therapy session at Rena Psychotherapy. This offering is designed for individuals who are in urgent need of support but unable to access therapy due to financial barriers.

This is a one-time, 50-minute session intended to offer short-term emotional support.
Current clients of Rena Psychotherapy are not eligible.
This offer is limited to Ontario residents only.
This is not an ongoing therapy arrangement or a substitute for long-term care.
This is not a crisis or emergency support service. If you are in immediate distress, please contact a local crisis line or emergency services.

If eligible, please complete the form below to be added to our waitlist. You will be contacted directly if a session becomes available.

Full Name * Email Address * Phone Number * Age * City/Province of Residence * Are you in immediate crisis, experiencing suicidal thoughts, or at risk of harming yourself or others?

Yes

What brings you to seek this one-time session? * Do financial limitations currently prevent you from accessing therapy? *

Yes No Prefer not to say

Do you understand that this is a one-time, 50-minute session and not an ongoing therapeutic relationship? *

Yes No

Are you currently working with a therapist, counselor, or mental health professional? *

Yes No

We're Really Sorry You're Feeling This Way

This free session offering is not designed for crisis or emergency support. We want to make sure you get the immediate care you need.

If you are in crisis or experiencing thoughts of self-harm or suicide, please reach out to one of the following 24/7 crisis resources:

Talk Suicide Canada – 1-833-456-4566 or www.talksuicide.ca
Wellness Together Canada – Text WELLNESS to 741741
Kids Help Phone – 1-800-668-6868 or text CONNECT to 686868
If you're in immediate danger, call 911 or go to your nearest emergency room.

We are unable to continue with the form submission, but please know you are not alone—help is available right now.

Free Therapy Session Waitlist Form

We're Really Sorry You're Feeling This Way

Rena Psychotherapy

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