Confidential Referral Form

This form is confidential and encrypted

Thank you for your referral! Dr. Bovell provides online psychological services for individual adults (ages 17-67), residing in Ontario. The therapy session fee is $215 per 55-minute session and there is no sliding scale. This is an online business, therefore, only MasterCard, Visa, Visa Interact Debit and MasterCard Interact Debit cards can be used for payments (cash, check, or e-transfers cannot be accepted). Direct billing is available for some insurers through TELUS eClaims. Dr. Bovell is available for appointments on Mondays, Tuesdays, Wednesdays, and Saturdays in the afternoon and evening.

Online psychotherapy or e-therapy is available for the following concerns:

Depression and mood disorders
Anxiety disorders (GAD, social anxiety disorder, OCD, health anxiety, panic disorder)
PTSD and trauma
Negative thoughts
Worry and stress
Low self-esteem
Life transitions

How would you like to send your referral?

Upload a separate referral form Complete the fillable form below

Referral Source Name

Referral Source Email Address

Referral Source Fax Number

Optional

You will be notified if your referral is accepted or declined. Which do you prefer?

Email Notification Fax Notification

Tell us who you are

(e.g., Family Doctor, Therapist, family member, friend etc.)

Please Upload Your Referral Form PDF or DOC files only

Add file

Please upload a file

Referred Person's Name

Referred Person's Age or Date of Birth

Dr. Bovell is only registered to see adults (ages 17-67) not children or seniors

Email address

Phone Number

Address

Province

Only referrals for Ontario residents can be accepted

Please describe the referred person's presenting problems or concerns.

Is there anything else we should know?

Your information will be encrypted.

Candice Bovell Ph.D., C.Psych.

Clinical Psychologist and Founder, Wellness View Psychological Services Ontario

Online psychotherapy for adults in Ontario

Phone #: 1-877-804-2048 ex. 100, Fax: 1-833-968-0309
www.wellnessview.ca
candicebovell
Toronto, Ontario, Canada