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DIRECT INSTRUCTION

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COACHING

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PARENT SUPPORT

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SCHOOL OUTREACH

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ASSESSMENT TREATMENT

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BLOG

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GET IN TOUCH WITH US

Please click the button below to register.

Contact Us
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If you would like to speak to a member of our team before getting started, please contact us at 833-482-5558 or email info@possibilitiesclinic.com

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).

Physician Referral Form

OUR SERVICES ARE PROVIDED BOTH IN-PERSON AND THROUGH TELEMEDICINE THROUGHOUT 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. We are also accepting referrals through OCEAN.
 

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

Intake Form

This form is required to start the process for an assessment, or for coaching, psychotherapy, and/or academic services, and to ensure we can offer you the service(s) you require.

Requested Documents

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

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.

 

Intake Form

This form is required to start the process for an assessment, or for coaching, psychotherapy, and/or academic services, and to ensure we can offer you the service(s) you require.

Requested Documents

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

Follow-up Forms (Ages 18+)

 

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

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

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

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

 

Get in touch with us

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Stickley Sticks To it!
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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!

Stickley Sticks To it!
Cinderella-Large
Marvin-Cover

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!

Testimonials