If you are therapist of the True North Psychological Services team, please use this secure form to submit your request.

We will be in touch with your patient soon and will put them in contact with one of our qualified physiotherapists. Feel free to contact us if you have any questions.

Name of the patient

First Name

Last Name

Email of the patient

Phone number of the patient

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Reason for referral

Please summarize the main reason for referral.

Name of the professional referring

Please enter your contact information so that we can reach out in case we need more information.

First Name

Last Name

Profession of the person referring

Email of the person referring

Phone number of the person referring

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