PROFESSIONAL REFERRALS

Referrals to NuVista
Mental Health

Please complete this secure referral form if you are a physician, healthcare provider, or community professional referring a client for assessment or therapy. Required fields are marked with a red asterisk.

"*" indicates required fields

REFERRAL SOURCE DETAILS

Title*

Referral source Organization Name*

Referral Source Name*

Referral source First Name* Referral source Last Name*

Tell us who you are*

Referral source email*

Referral source phone*

CLIENT INFORMATION

Clients Name*

Clients First Name* Clients Last Name*

Clients email*

Location*

Client's date of birth

Clients phone*

Insurance Company / WSIB Claim Number / Veteran K#

Presenting concern / Reason for referral*

Select a Service*

If client is a minor, provide as much guardian information as you can

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Have a Question? We’ve Got You

We would be happy to hear from you with any questions you may have, or to enquire about booking sessions with one of our qualified clinicians.

Referrals to NuVista
Mental Health

REFERRAL SOURCE DETAILS

CLIENT INFORMATION

Have a Question? We’ve Got You

NuVista Mental Health

True North Psychological Services

NuVista Sleep Solutions

NuVista Psychedelic Medicine

Need Immediate Help?

1-866-531-2600

1-800-667-5005

1-866-531-2600

Referrals to NuVista Mental Health

REFERRAL SOURCE DETAILS

CLIENT INFORMATION

Have a Question? We’ve Got You

NuVista Mental Health

True North Psychological Services

NuVista Sleep Solutions

NuVista Psychedelic Medicine

Referrals to NuVista
Mental Health