Clinical Referral Form
Our clinical team are eager to connect with you to initiate our services.  To learn more about our services, please see our website at:  For more information, please feel free to email us at: 

This referral form is a seamless, easy and efficient way to initiate counselling or psychotherapy services.  We offer services to adults (18 and up), children (2 to 11), youth (11 to 24), couples and families.

The information you provide will help to gear services that will meet your needs and connect you with a therapist as soon as possible.  

The information used in this referral form will help to guide your initial appointment.  

Thank you for your participation.
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