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Referral Forms

Please click on the appropriate form and it will open in PDF. You can type into the form and save it. You can email us the completed form or print then fax to us. The contact information can be found in the forms.

Adult Referral Form

Child/Youth Referral Form (up to 19 years old)

You will need to download the form to your computer first. Then open the form from your computer, type in the ¬†information then you can save the completed form. It would be helpful for us if you save it with last name in the file name – “WBP lastname”.

If you don’t download the form into your computer, all the typed information won’t be saved onto the form.

If you need a referral to see our on-site psychiatrist, please have your doctor contact us for the referral form as it needs to be signed off by your doctor.