Online Patient Referral Form

Please fill out our secure online referral form if you are:

  • a new client (or a loved one of a new client) looking for assessment, treatment, or consultation,
  • a physician or mental health clinician looking to refer a new client,
  • not sure which clinician would be a better fit to what you are seeking, or
  • seeking DBT (including DBT-informed therapy, skills group only, or comprehensive DBT service)

Printable Referral Form

If you prefer, you may print and fax our printable referral form to 604-630-7062.

We accept self referrals. A referral from a physician is not required.

Please note that we are not an ICBC vendor and we do not accept ICBC and WorkSafe BC referrals. Further, not all of our psychologists work with individuals with funding from long term disabilty insurance.  

Once we review the referral request, we will try our best to connect you with one of our available clinicians based on fit between your reasons for seeking services and a clinician’s scope of practice, as well as your preferences and availability for appointments. Please note that certain services/clinicians may have a wait time. A referral list to other service providers is available upon request should we not able to connect you with one of our psychologists. 



Information collected in the online referral form will be sent directly to our secure clinic email ( In the event that no clinical service is provided for any reasons, the information collected will be destroyed.

Please understand that while we vouch to connect you with one of our clinicians, we cannot guarantee service provision. We also cannot gurantee goodness of fit between you and a clinician initially assigned to you. You may request an initial, brief phone consultation (10-15 mins) with the assigned clinician before booking your first appointment. Thank you for your patience and understanding.

Referrals for the DBT Program

Due to the overwhelming demand for comprehensive DBT, regrettably we have decided to close referrals to the program at this time to allow us to process the existing referrals. Please check back later for update. We are still accepting referrals to our DBT skills groups. To join group, a client needs to be under the care of an individual clinician and meet with the clinician regularly. Check out our group therapy page for more information.