Client Referral Form [PRC]
Our dedicated team of Registered Psychologists and Psychological Associates at the Psychological Recovery Clinic is focused on serving a wide range of clients by providing psychological services across the Greater Toronto Area, Canada. 

18 Wynford Drive, Suite 714, Toronto, ON M3C 3S2 | Tel: 416-939-4290, 647- 342-5444 | Fax: 647-342-7000 | eFax: 416-900-3275 | www.PsychologicalRecovery.com | info@psychologicalrecovery.com
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Type of Loss/Injury
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Client Details *
Please Add*: Contact Information including his/her Telephone Number and Address. *Please DO NOT include Client's Name.
Insurance Claim Details *
Please Add: Claim #, Policy #, and Date of Loss, Name of Insurance Company, Adjuster Name, Tel and Fax, if any
Assessment Required              
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Treatment Required
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Your contact information
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