Referral Form

Use the form below to submit a private and confidential request for a Psychotherapist Referral now.

Please select your city and fill out the rest of the form, and an experienced Psychotherapist from the Referral Network will respond. Your information will be treated with utmost care for your privacy. If you provide a phone number, please also indicate whether it is alright to leave a message.

If you are not comfortable submitting the online form, please feel free to call one of the Referral Lines:

  • If you’re located in the St. Catharines and Niagara region, call 905-682-3064. 
  • For a referral to a Toronto Psychotherapist or psychotherapists and counselors in other Ontario cities, call 416-920-9355.

Referral Request Form

  • This field is for validation purposes and should be left unchanged.