REFERRAL FORM

Referral Form

CBT Niagara is a private, fee-for-service psychological clinic offering individual cognitive behaviour therapy. Our services are not covered by OHIP although psychological services are often covered through extended health care plans.

 

Please note: We do not accept any referrals which are MVA related. Also, our therapists provide services to patients ages 14+ years old.

Sex
May we leave you a voice message?

Symptoms You're Experiencing

Referral Information

Do you have extended health insurance?
Type of therapist covered under insurance:
Are you a veteran?
Are you a first responder?
Are you currently off work due to your mental health?
If yes, occupation?

Please check your 'junk mail' for our email response!

Thanks for submitting!

If this is related to a critical work incident, how long ago did the event/call occur?