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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.

*Due to the confidential nature of this referral form and its contents, please only submit the completed document by fax to 613-801-1433 or encrypted PDF to in order to best protect client information. Please call 613-631-1097 to request a password.

The form is completely fillable electronically but can also be printed and signed in-person. Please note that the user will have to select the service type and urgency prior to printing to effectively use the drop-down menus.