Make a referral

Submit a Referral

Use the form below to refer an individual for mental health services with TherapySupports. Please provide the requested details so we can review the referral and determine the appropriate next steps.

Name of the Referring Clinic/ Office*

Email Address*

Contact number of the Referring Clinic/office*

Name of the Referred Client*

Is the client an Adult? If not, please type the name of the Caregiver*

Contact number and email of the referred client/ patient.*

Reasons for referral.*