Centre for Psychology and Emotional Health

CBT for GAD Online Intake Form

Cognitive Behavioral Therapy (CBT)

for Generalized Anxiety Disorder (GAD):

An evidence-based group that teaches skills to manage excessive worry

with Dr. Jinny Hong, Ph.D., Psychologist and Dr. Virginia Boquiren, Ph.D., Psychologist

Please complete the following online intake form for Dr. Hong and Dr. Boquiren to assess fit for the group. However, if you would prefer to complete the intake over the phone, please click the button below to schedule a time with our intake team.

Book an Intake Call

Group Therapy Intake Form

Name:

Pronouns:

Birth Year:

Email:

Phone:

In the past have you been provided a formal mental health diagnosis or assessment with a doctor of any kind? If so, please provide further details.

Do you have any history or current concerns of self-harm? If so please provide further details.

Do you have any active concerns regarding substance misuse or addictions? If so, please provide further details.

Do you currently struggle with excessive worry and anxiety? This is worry that is constant and hard to control.

Yes

Do you excessively worry about multiple areas of your life; e.g., work, school, relationships, the future, finances, your and/or others' health, etc.? If so, please provide examples.

Does your excessive worry cause you problems/difficulties in your life; e.g., physical issues like muscle tension, fatigue, sleep difficulties, concentration or focus problems, difficulty staying present, etc. If so, please provide examples.

CONTACT US

(647) 492-3539

(416) 519-7904

hello@cpeh.ca

1200 Bay St. Suite 403

Toronto, ON

Canada

M5R 2A5

Physician Referral -

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Fax: 416-901-7905