Client, Teacher, and Physician Forms

Below you will find all the forms necessary to begin your Assessment or Treatment. Expand the category to see form(s).

Child and Adolescent Intake and Consent Forms

These forms are required to start the process for an assessment and to ensure we can offer you the service(s) you require.
Child and Adolescent Intake and Consent Forms

Direct To Therapy and Coaching Intake and Consent Forms

These forms are required to start the process for coaching, psychotherapy, and/or academic services and to ensure we can offer you the service(s) you require.

Direct To Therapy and Coaching Intake Form

Requested Documents

Please send Report Cards, IEPs, and other relevant documents such as previous psychological reports. Files must be in pdf format.

Attach Documents

Follow-up Forms (Ages 1-17)

This form should be filled out if requested by your practitioner. You must be a registered patient with the clinic and have an upcoming appointment scheduled.

Child and Adolescent Summary Report Form_Short Form
Patient Self Report Form
 

Adult Intake and Consent Forms

These forms are required to start the process for an assessment and to ensure we can offer you the service(s) you require.
Adult Intake and Consent Forms

Direct To Therapy and Coaching Intake and Consent Forms

These forms are required to start the process for coaching, psychotherapy, and/or academic services and to ensure we can offer you the service(s) you require.

Direct To Therapy and Coaching Intake Form

Requested Documents

Please send Report Cards, IEPs, and other relevant documents such as previous psychological reports. Files must be in pdf format.

Attach Documents

Follow-up Forms (Ages 18+)

 

Patient Self Report Form

Physician Referral Form

DURING COVID-19, ALL OUR SERVICES CONTINUE TO OPERATE USING TELEMEDICINE ACROSS ONTARIO.
To refer a patient, please download our referral form below and fax the completed form to 1-833-482-8999. Alternatively, you can complete our online e-referral and submit it directly through our website.
 
Please note that we cannot accept referrals for court or medico-legal purposes, and/or cases with unresolved custody/access issues.
Download PDF
e-Referral

Are you a Teacher? (Age 5 – 17 Student)

If a student has requested you provide feedback, kindly fill out our online form.

Teacher Survey

Are you a Teacher? (Age 1 – 4 Student)

If a student has requested you provide feedback, kindly fill out our online form.

Teacher Survey
 

Physician Referral Form

DURING COVID-19, ALL OUR SERVICES CONTINUE TO OPERATE USING TELEMEDICINE ACROSS ONTARIO.
To refer a patient, please download our referral form below and fax the completed form to 1-833-482-8999. Alternatively, you can complete our online e-referral and submit it directly through our website.
 

Please note that we cannot accept referrals for court or medico-legal purposes, and/or cases with unresolved custody/access issues.

Download PDF
e-Referral

Get in touch with us

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Visit our Shop!

Selected and curated by experts at our clinic

Learn, engage, and explore wondrous possibilities—for you and your family—in our new Possibilities Shop. Our store has expertly curated products recommended by our clinicians, and we’re excited to share them with you! Browse books we love for kid-friendly reading or deep insights, explore therapy tools, challenge your mind with some Brain Fun, or check out our Lifestyle section to enhance your life at work or home. We’re speaking with creatives, inventors, and visionaries about brand new products, too. So stay tuned—we’re just getting started!

Our Shop

Visit our Shop!

Selected and curated by experts at our clinic

Learn, engage, and explore wondrous possibilities—for you and your family—in our new Possibilities Shop. Our store has expertly curated products recommended by our clinicians, and we’re excited to share them with you! Browse books we love for kid-friendly reading or deep insights, explore therapy tools, challenge your mind with some Brain Fun, or check out our Lifestyle section to enhance your life at work or home. We’re speaking with creatives, inventors, and visionaries about brand new products, too. So stay tuned—we’re just getting started!

Our Shop
The doctor was very knowledgeable and the staff so friendly and helpful. My daughter did the ME Zone Jr group and it has helped her to understand and control her emotions. The clinic has made a difference in our lives.
Alex
Lots of possibilities at the Possibilities Clinic! The individual therapy option provided to us at the clinic is really helping our son. He is a much happier kid.
Karen
The clinic offered me several options to help my son and my family deal with his ADHD. The therapy sessions with the social worker have been great. And she comes to our home! Thank you Possibilities.
Suzanne
This place is a treasure. I've had to get a few psychoeducationals for my family. These are not easy and the quality is all over the place.
George
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