To refer a patient or client, please complete the forms included in our referral package below and submit it to us by email or fax.
Note: Referral documents must be completed by the referring physician or support provider on behalf of your patient or client.
In addition to the referral package, a complete referral should include the following forms or assessments:
For substance use concerns:
- Admission Discharge Assessment Tools (ADAT) and Drug History Questionnaire (DHQ)
- GAIN-Q3 Recommendation and Referral Summary (Q3RRS) and Diagnostic Impressions Report
For gambling concerns:
- Ontario Substance Abuse Bureau (OSAB) Gambling Data Form
- South Oaks Gambling Screen (SOGS)
- BASIS for gambling clients
For substance use and gambling concerns:
- OSAB Gambling Data Form, SOGS and BASIS
- ADAT and DHQ or Q3RRS (no DHQ) and Diagnostic Impressions Report
How to Submit
All required documents must be submitted together to process the referral. Once all required documents have been completed, they can be submitted to our intake team by fax or email.
- By Fax: 416-255-9021
- By Email: firstname.lastname@example.org
Note: If submitting by email, we recommend password-protecting your documents for privacy reasons. Please send the password-protected documents by email, and provide the password in a separate email.