Wise Mind Centre Referral Form

Please correct the errors described below.

REFERRAL SOURCE:

CLIENT INFORMATION:

REASONS OR CONCERNS FOR SEEKING TREATMENT

We appreciate your referral. Once we receive your referral form, we will try our best to connect you with one of our clinicians as soon as we can. Please note that due to overwhelming demand for services, there could be a wait time for clinicians depending on the type of service you are seeking, your preferences, and availability for appointments. Wait time for online / virtual appointments is relatively short. Wait time for clinicians with DBT training is longer. Thank you for your patience and understanding.

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