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MDPAC COVID-19 Project - Physician Psychotherapists Information
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1.
Please enter your full name as you want listed, including your designations (e.g. MD, CCFP or FRCPC etc.)
(Required.)
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2.
Please indicate your contact information that will be provided to prospective patients:
(Required.)
Email
Telephone
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3.
What gender do you identify as?
(Required.)
Female
Male
Non-binary
Transgender
Gender fluid
Prefer not to say
Other (please specify)
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4.
Please indicate your practice location: (NOTE: Even though therapy will start as remote, some patients may want the option of in-person follow-up after the pandemic is over)
(Required.)
Province
City
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5.
Which of the following conditions are you comfortable treating? Check all that apply.
(Required.)
Abuse
Addiction
ADHD
Anxiety
Bipolar Disorder
Childhood/adolescent counseling
Chronic pain and associated stress
Couples counseling
COVID -19 related situational stress
Depression
Eating disorders
Financial or employment stress
Grief
Marital or parental stress
OCD
Personality Disorder
Psychotic Disorder
PTSD
Trauma
Work-related stress
Other (please specify)
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6.
Please indicate the type of therapy that you are able to offer. Check all that apply.
(Required.)
Adult Medication Management
Child and Adolescent Medication Management
Cognitive Behavioural Therapy (CBT)
Combination/Eclectic Therapy
Couples Therapy
COVID -19 related situational stress
Eye Movement Desensitization and Reprocessing Therapy
General Psychotherapy
Group Counselling
Interpersonal Psychotherapy (IPT)
Mindfulness Based Therapies
Psychoanalytic
Psychodynamic
Supportive
Other (please specify)
7.
Please indicate which groups you feel comfortable treating. Check all that apply
Under Age 13
Between Ages 13-18
Between Ages 18-65
Over Age 65
Other (please specify)
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8.
Please indicate the number of planned sessions per new patient:
(Required.)
6 Sessions
8 Sessions
10 Sessions
12 Sessions
Unspecified/Number of Sessions to be Determined
Other (please specify)
