Please Call (18886916111), e-mail  (infocmap@hushmail.com) or book with a therapist directly online from our website

Contact Us for Help
Alberta: 330 5TH Avenue SW, Suite 1800 Calgary , AB T2P 0A4 (Virtual only, in person coming soon)

Alberta Psychiatry Consultation Referral Form

REFERRAL SOURCE

PLEASE NOTE: IF YOU ARE NOT THE CLIENT’S GP AND DO NOT CONSENT TO FOLLOW-UP CARE, THE REFERRAL WILL BE DECLINED

CONSENT

CLIENT INFORMATION

REASON FOR THE REFERRAL