Client, Teacher, and Physician/Nurse Practitioner Forms
Referral Form
OUR SERVICES ARE PROVIDED BOTH IN-PERSON AND THROUGH TELEMEDICINE THROUGHOUT ONTARIO
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+)
Parent Consent Form
Telemedicine (Video) Consent Form
Assessment and/or Treatment Consent Form
Medication Adjustment Agreement
Consent to Share Information Form
Payment Policy and Guidelines
Disability Tax Credit Certificate (DTCC) Agreement and Understanding
Teacher Referral
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.
Please note that we cannot accept referrals for court or medico-legal purposes, and/or cases with unresolved custody/access issues.
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.
Learn More, Get Started!
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!
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!
