Refer aIf you’re a healthcare professional or campus counsellor looking to make a referral, please complete the form below Patient Student Patient Student Patient Student Client's Name * First Name Last Name Client's Email * Client's Phone Number (###) ### #### What services are you referring them to? * Individual Therapy Couples Therapy What province or territory do they live in? * What is the client needing support with? * Name of Referring Organization or Professional * First Name Last Name Do you have the client's permission to share their information with us? * Yes The client consents to Change Therapy following up with them regarding their care? * Yes How did you hear about us? Thank you for referring a patient or student to our services! Our team will be in touch with them soon to help them get started.Inquiries are typically responded to within 24-hours and on business days.If you are in crisis or do not feel safe, please visit your nearest emergency department, call 9-1-1, or call 9-8-8 for the national suicide and crisis helpline. Change Therapy does not provide crisis response services, and it is very important that you get the most immediate and appropriate support if you are in crisis.
