Child/Youth or Self Referral

Referrals are accepted for Counselling and Therapy. Completed Referrals can be sent through the online referral form below.

Referrals can also be made by phone to Intake at 1-800-809-2494.

If you are a parent and would like to complete our online referral form to connect your child/youth with our service please CLICK HERE.

If you are a child/youth 12 years or older and would like to be connect with us for service please CLICK HERE.

 

Third Party Referral

Referrals are accepted for Counselling and Therapy. Completed Referrals can be sent through the online referral form below.

Referrals can also be made by phone to Intake at 1-800-809-2494.

If you are a community partner or service provider and you have your client’s consent to make a referral to our agency for serviceĀ CLICK HERE.

To complete a referral, the following information must be included:

  • Client consent, name and contact information
  • Permission to call
  • Preferred language and ethnicity
  • Next of Kin and custody
  • Reason for referral and presenting issues
  • Risk factors
  • Information about the referring party

Once a referral is submitted, you will receive a link that will allow you to check the status of your referral.

By proceeding with the completion of this referral form, you are acknowledging that your client/patient has provided you with consent to complete this referral on their behalf.

 

Children’s Mental Health of Leeds and Grenville is a Canadian Registered Charity BN#896698495RR0001