CMAP Health is OPEN and committed to offering uninterrupted, secure services through remote audio/ video platforms.

Call, e-mail or book with a therapist directly online from our website.

Contact Us for Help
243 Perth Street, Brockville, Ontario, K6V 5E7 (FREE PARKING AVAILABLE AT BOTH LOCATIONS)

Health Care Practitioner Referral

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

If previous psychiatry assessments were provided - please fax as well