Forms

Referral Form for

Health Care Professionals

The Referral Form For Health Care Professionals is a confidential* document that can be used by medical or mental health personnel to direct patients to the counsellors at Forging Forward Counselling Services. The patient is asked to consent to email communication including the receipt of electronic in-take forms from our secure practice management system.

Important Notice

*Due to the confidential nature of this referral form and its contents, please only submit the completed document by secure facsimile to 613-775-0615 or encrypted PDF to forging.forward.counselling@gmail.com in order to best protect client information.

Please contact our client care coordinator at 613-366-2967 to request a password.

Printable

The form can be easily printed and signed in-office. This PDF does not contain dropdown menus which makes it simpler to fill out in-person.

Fillable

The form is a completely fillable PDF that can also be signed electronically. This version contains drop-down menus and clickable check-boxes.