Date *
Date
Patient Name *
Patient Name
Date of Birth
Date of Birth
Parent/Guardian Name (if applicable)
Parent/Guardian Name (if applicable)
Patient (or Parent/Guardian) Contact *
Patient (or Parent/Guardian) Contact
Physician Name
Physician Name
Physician Contact
Physician Contact
Referral Source (if other than physician)
Referral Source (if other than physician)
Referral Contact
Referral Contact
Type of Counselling
PRESENTING PROBLEM for Counselling/Psychological Services:
Has the patient given permission to share this confidential information with River's Edge Counselling Centre? *
 
Professional referrals

Professional referrals

Please note: This form is for other professionals wishing to make a referral to River's Edge Counselling Centre. If you are interested in receiving counselling services for yourself, please use the form on our Contact page, or call the Centre directly, and we will be pleased to help you find a therapist and book a session.

Please Note:

Patients will be contacted by River’s Edge Counselling Centre staff within 24 hrs on weekdays.

If patient provides written consent, a letter outlining assessment and treatment plan will be sent to the referring physician to coordinate care.

River’s Edge Counselling Centre staff will strive to match each patient with a therapist that best meets their needs in terms of specialization, hours, fees and personality. Our graduate student training program allows us to offer lower cost services to clients with no insurance or the means to pay regular fees. If we cannot meet the specific needs of a patient, we will work together to find an appropriate referral in the community.

Why refer to a team?

Clients get the help they need, by the professional best able to meet their needs. Our intake process is where our relationship with clients begin, and it forms the foundation for effective care. We spend the time needed with every person referred to us, to ensure they find the right ‘fit’ on our team. If we are unable to meet their needs for any reason, we work with them to ensure they receive an appropriate referral. The care clients receive is enhanced by the shared experience and wisdom of the entire team. Our therapists have chosen to work in a team environment because they value collaboration and the opportunity to learn from colleagues. As a team, we work closely together, to ensure clients reach their goals for health and happiness in their lives and relationships.