This form is available to refer a client to most CMMHC services, except for ACT or IRTS services. Please make a referral by completing the following fields and clicking submit or print off the form and fax it to the client’s preferred clinic location. If referring more than one client in the same family, please list all names on one form and only submit once.

For ACT or IRTS referrals, please select this link and you will be directed to the appropriate page. Please note, records are needed for referrals to ACT and IRTS services.