Registration

To book an appointment with our therapists, we require you to first register by completing this form. It is important for us to understand any insurance coverage you may have before you book a session. Please complete this form below and if everything is good, then we'll make your account in the system or enable online booking in your account so you can then book with one of our therapists. If we require clarification from you, we will contact you for more information.

First Name

Last Name

Email Address

Re-Type Your Email

What university/college do you attend?

If you're using insurance is it:

What is your student number? We ask this because we typically need your student number to check your insurance and bill your insurance for any sessions you have through us.

What is your birth date? (Please put in the format of "Month, date, year"). We ask this because it's often needed for us to check and bill insurance plans.

If you would like us to text you when you're registered, please leave your phone number below. You will receive an email, but sometimes emails will go into your junk folder, so by asking us to text you you won't miss the notification.

Would you like us to call you if we see you haven't booked an appointment within a few days to see if you need help picking a therapist, using our website, or would like help booking?

How did you hear about us?

To ensure you don't miss our email, please check your junk folder over the coming days in case our email goes there. Check this box to indicate you know to keep an eye out for our email.

I consent to you checking my insurance coverage, (if applicable), contacting me via phone or email, and making me an account in your system.

I accept the Terms of Use and Privacy Policy of My Student Wellbeing