Contact Information
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Organization Information
*Name of Organization :
*Street Address :
*Region : ---------- Select ------------ Central East Central West Eastern Hamilton-Niagara North East Northern South East South West Toronto
*City : *Province : *Postal Code :
Email :
Website :
*Mental Health Services Provided : (select all that apply)
Assessment Case Management/Service Coordination Counselling/Therapy Crisis Management Health Promotion Medication Management Public Education Referral to Other Agencies Rehabilitation Respite Support Groups Telephone Support Services Other(s) :
*Mental Health Assesments Provided : (select all that apply)
Addictions Behavioural Cognitive Custody and access Developmental Forensic Neurological Occupational Physical Health Psychiatric Psycho-educational Social work Socio-emotional Speech/language We do not provide mental health assesments Other(s) :
Mental Health Practitioners: (select all that apply)
Child and Youth Worker Early Childhood Educator Family Physician Family Therapist Mental Health Nurse Nurse Occupational Therapist Pediatrician Physiotherapist Psychiatrist Psychologist Psychometrist Social Worker Speech-Language Pathologist Other(s) :
*Age groups served : (select all that apply)
0-6 years of age 7-11 years of age 12-15 years of age 16-18 years of age > 18 years of age
*Language(s) of Service : (select all that apply)
English French Aboriginal Other(s) :
Service Costs : (select all that apply)
We provide services for NO fee An Ontario Health Card is required to access these services Some of our services have a fee All of our services have a fee
*Hours of Operation :
Other notes or comments :
Additional Information :
Please tell us about your organization. This information will not be published with your profile, but it may be used by the Centre when your submission is reviewed. Is your organization: