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To add yourself to our waiting list, please fill out the contact form below or visit our practice management client portal by clicking the icon above.

Get in Touch

Name *

Legal name

The name we should put on receipts/use for insurance

Insurance info

If applicable

Pronouns *

Date of birth *

Email address *

Phone number *

Address *

Preferred language *

Date of Preferred

Type of therapy *

Location *

Availability *

ie Monday mornings, Tuesday evenings, etc.

Presenting issues

Include a brief summary of your reason(s) for seeking therapy. If you are seeking couples/relational/family therapy, please have each person fill out a form.

How did you hear about us?

Diverse Roots Therapy is located in Punamu’kwati’jk. We live and work on the unceded and ancestral land of the Mi’kmaq people.

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