Direct referral to Brave Mind Therapy

Client's full name

Email address

Phone number

Briefly (max. 3 sentences) explain the reason for this referral

Client's preferred date for an appointment

Appointments are available on Sundays, Mondays, and Tuesdays

Please confirm the following eligibility criteria:

Client is between the ages of 10-25 OR is a parent.

Referrals for parents supporting anxious children are welcome.

Client is not looking to to process past events (ex. trauma).

Client is aware of the referral and interested in goal-oriented, future-focused therapy.

Client has the means to pay for therapy (session rates are $160/50 mins, not covered by MSP).

Client displays signs/symptoms of anxiety of OCD.

Ex: rumination, overthinking, worries, negative self-talk, avoidance, unhelpful or unwanted thoughts, etc.

Referring provider name

Email address

Phone number

Organization name

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