Request a Consultation - Whole Heart Mental Health Clinic

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Client Name (this is the name of the individual you are seeking services for) *

First

Last

Email Address (this is the email of the person you wish for us to contact to discuss service) *

Important Eligibility & Exclusions

The patient must be physically located in Ontario at the time of the appointment.
This is not an urgent or crisis situation. If you are in crisis, call 911 or attend your nearest emergency department.
This request is not for court, custody, disability, insurance, or legal purposes.
We are unable to provide assessment or treatment for active substance use, psychosis, bipolar disorder, or eating disorders.
For patients under 18 years of age, all legal guardians must consent to and be aware of this request.

Please confirm the following before proceeding: *

I confirm that I have reviewed the eligibility criteria above and that this request meets these requirements

If there are immediate safety concerns or risk of harm to self or others, please call 911, contact 988, or go to your nearest emergency department.

Please concerns difficulties

Who is the appointment for? *

Parent / Caregiver Name (if booking for a child)

Phone Number (To schedule follow up) *

Briefly describe your concerns or what you’re looking for, and we’ll guide you to the right service. *

Psychiatry Consultation Services

Please select all psychiatry consultation pathways that may apply. You may select more than one.

Please select any psychiatry consultation services of interest. *

I am not interested in Psychiatry Services at this itme
Adult Psychiatry Consultation (23+): OHIP-covered. Referral required. Does not assess ADHD.
Child & Youth Psychiatry Consultation, under 23 (OHIP-covered. Referral required. ADHD may be reviewed when clinically appropriate.)

What concerns are you hoping to get support with? Please select all that apply. *

I am not sure
ADHD / attention / executive functioning
Anxiety / social, panic, excessive worry, etc
Behavioural concerns
Depression / low mood
Emotional regulation
OCD symptoms
School or learning concerns
Trauma / PTSD-related symptoms
Eating / nutrition concerns
Other

ADHD Assessment / ADHD Support

Please select all ADHD-related services or pathways that may apply. You may select more than one.

Please select the appropriate ADHD assessment and/or support pathways. You may select more than one. *

I am not looking for ADHD-related services
OHIP • Age 13 and Under • Family Physician ADHD Clinic Referral required. ADHD assessment and medication monitoring may be available.
OHIP • Under 23 • Child & Youth Psychiatry ADHD Consultation only Physician or nurse practitioner referral required. ADHD may be reviewed through Child & Youth Psychiatry when clinically appropriate.
23+ Nurse Practitioner ADHD Assessment and/or medication management
Private • Children, Youth & Adults • No referral required. Fees apply and may be covered in full or in part through extended health benefits or insurance plans.
Executive Functioning / Academic support
Private • Children, Youth & Adults • May include executive functioning coaching, educational support, tutoring guidance, therapy-based support, or school/work strategies.
Parent Coaching / Family ADHD Support
Private • Parents & Caregivers • Support related to routines, emotional regulation, school challenges, behaviour management, and ADHD-related family stressors.
Occupational Therapy for ADHD / Executive Functioning Support
Private • Children, Youth & Adults • May support organization, routines, sensory strategies, emotional regulation, task initiation, independence, and daily functioning.
I Already Have an ADHD Diagnosis and Am Seeking Medication Consultation / Treatment Support
Private or OHIP pathway depending on age, referral status, and provider availability.
I Am Not Sure Which ADHD-Related Service or Pathway Fits Best
Our team can review your concerns and help guide you toward the most appropriate support or assessment pathway.

Do you currently have a referral from a physician or nurse practitioner?

Yes
No (Required for OHIP Psychiatric Consultation, ask your doctor to send a referral in (this can be found on our website) and then email us for an appointment booking link):ADHD assessments are not offered under OHIP for adults 23+ at this time.
UNSURE

A referral is required for all OHIP-covered psychiatry appointments.

ADHD assessments for patients age 23 and older are not covered under OHIP psychiatry and are completed privately through our Nurse Practitioner team for a fee.

Therapy & Counselling Services

Please select all therapy or counselling services that may apply. You may select more than one.

Therapy, Counselling & Wellness Services *

I am not looking for therapy
I Am Not Sure Which Therapy or Counselling Service Fits Best
Our team can review your concerns and help guide you toward the most appropriate therapy pathway or clinician.
Individual Therapy / Counselling
Private • Children, Teens & Adults • Support for anxiety, mood, stress, trauma, emotional regulation, self-esteem, life transitions, ADHD-related concerns, and coping skills.
Family Therapy
Private • Families & Caregivers • Support for communication, conflict, parenting challenges, emotional regulation, family stressors, and relationship dynamics.
Couples Therapy
Private • Adults • Support for communication, relationship concerns, conflict resolution, connection, and life transitions.
Parent Coaching / Parenting Support
Private • Parents & Caregivers • Support related to routines, emotional regulation, behavioural challenges, parenting strategies, school concerns, and family functioning.
Therapy for ADHD, Executive Functioning, or Emotional Regulation
Private • Children, Teens & Adults • May support organization, attention, emotional regulation, anxiety, school/work functioning, coping skills, and daily functioning.
Psychoeducational Assessment
Private • Children, Teens & Young Adults • Assessment of learning, attention, academic functioning, giftedness, learning disabilities, and school-based needs.
Pharmacy Consultation
Private • Children, Teens & Adults • Medication review, side-effect review, treatment optimization, and medication-related recommendations integrated into the overall care plan.
Nutrition Services
Private • Children, Teens & Adults • Nutrition support for ARFID, binge eating concerns, restrictive eating, weight-stable eating concerns, family meals, emotional eating, ADHD-related eating challenges, and overall wellness.
Naturopathic Medicine (Coming Soon)
Private • Children, Teens & Adults • Integrative wellness-focused care to support physical and mental health concerns. More information coming soon.

Preferred Therapy Modality *

In Person
Virtual
Either

Preferred location for Therapy (select all that apply) *

Toronto – Yonge & Davisville
North York – Duncan Mill
Bathurst & Eglinton
Ajax
Virtual Appointment

Preferred therapy appointment times (select all that may work) *

Weekday mornings
Weekday afternoons
Weekday evenings
Saturdays
Sundays

ADHD Symptom & Executive Functioning Screener

Please complete the brief screening questions below. This screener is intended to help identify whether ADHD-related symptoms or executive functioning concerns may require further assessment or support.

This is a screening tool only and is not a diagnosis. ADHD symptoms can overlap with anxiety, depression, trauma, sleep difficulties, learning differences, and other mental health concerns.

QUESTION 1 How often are there difficulties with attention, focus, or staying on task?

Never
Rarely
Sometimes
Often
Very Often

QUESTION 2 How often are there difficulties with organization, planning, or completing tasks?

Never
Rarely
Sometimes
Often
Very Often

QUESTION 3 How often are there concerns about forgetfulness or losing important things?

Never
Rarely
Sometimes
Often
Very Often

QUESTION 4 How often are there difficulties getting started on tasks that require mental effort or sustained attention?

Never
Rarely
Sometimes
Often
Very Often

QUESTION 5 How often are there concerns about restlessness, excessive movement, or difficulty sitting still when expected?

Never
Rarely
Sometimes
Often
Very Often

QUESTION 6 How often are there concerns about impulsivity, interrupting, emotional reactivity, or acting without thinking?

Never
Rarely
Sometimes
Often
Very Often

Consent *

I consent to being contacted by Whole Heart Mental Health & Wellness regarding my consultation request.