We are not a crisis service.If you or someone you know is in immediate danger, please call 9-1-1We are not a crisis service.If you or someone you know is in immediate danger, please call 9-1-1We are not a crisis service.If you or someone you know is in immediate danger, please call 9-1-1
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Shades of Wellness Toronto

Referral form

A simple next step for your care provider.

Our Client Referral form is to be completed by your Family Doctor or Nurse Practitioner — fill it in below and send it directly to us.

Shades of Wellness Toronto

Psychotherapy Client Referral Form

3701 Chesswood Drive, Suite 210, Toronto, Ontario M3J 2P6 · Office (416) 633-7340 · Fax (416) 633-1941

Client
I

Client

Concern & Diagnosis
II

Concern & Diagnosis

Please specify.

Referring Practitioner
III

Referring Practitioner

Sent securely to info@shadesofwellness.ca — no download needed.

Prefer paper? Download the PDF