Submit a Referral

Complete the form below and a member of our clinical team will review the referral and follow up as needed

All referrals are confidential and reviewed by our clinical team

For physicians and nurse practitioners. Psychiatry is consultation only, and care is returned to the referring provider. Prefer to fax? Download our PDF referral form and fax it to 289-372-0463.

Patient information

Patient Name
Required. We email the patient their booking link here.

Reason for referral

Psychiatry consultation (OHIP, consultation only)
Nurse Practitioner services (private fee, not covered by OHIP)
Some benefit plans cover these. Patients should check with their insurer.
Other private services the patient may be interested in (optional)
Not covered by OHIP, no referral needed. Our therapy team will contact the patient.

Clinical information

Check all that apply
Has this patient seen a psychiatrist?
Is the patient under the care of a psychiatrist now?
Is this a Whole Heart client?

If the patient has seen a psychiatrist, please email reports to intake@wholeheartmentalhealth.com.

Referring physician or nurse practitioner

We send you a confirmation here.
I acknowledge

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