referral form

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The completed referral form is to be faxed to 343-888-2500. 

All referrals are to be issued by a health provider who is responsible for the patient’s medications and medical care. Dr. Burgess will then contact the patient and request that they complete an intake questionnaire prior to their first appointment. 

A consultation letter will be sent back to the referring physician after the initial assessment if it is deemed that the patient would benefit from a different level or scope of psychological expertise than Dr Burgess can offer. Otherwise, a discharge letter will be sent to all referring physicians at the conclusion of therapy. 

Together as practitioners we can do our part to increase accessibility to psychotherapy by prioritizing who gets referred to our OHIP-covered service: We ask  to consider patients who do not not have access to private insurance that covers psychotherapy or counselling services (in part or in full, through private insurance, their workplace, disability programs or any other avenue).

If you do not have a primary caregiver and wish to inquire about working with Dr Burgess, you can inquire by sending an email to info@mindfulwithsyd.ca