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Tools and Resources > Child and Youth Mental Health Services Directory - Submit Your Profile

Contact Information

* Indicates a required field

*First Name :
*Last Name : 
Job Title:
*Email :
*Telephone : () - ext.

*Would you like your contact information published with your organization listing? Y N
Would you like subscribe to CHECKPOINT, the Centre's quarterly e-bulletin? Y N

How did you hear about the Centre? 

Login Information

Please create a login name and password so you can continue to access and edit your online profile as required.

*Create a User Name :
*Create a Password :
*Confirm Password :

Organization Information

*Name of Organization :

*Street Address :

*Region :  

*City :      *Province :      *Postal Code :

*Telephone : () - ext. (general inquiries)
Fax : () -
Crisis Line : () -

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 :

Monday Open : Close : 24 hrs
Tuesday Open : Close : 24 hrs
Wednesday Open : Close : 24 hrs
Thursday Open : Close : 24 hrs
Friday Open : Close : 24 hrs
Saturday Open : Close : 24 hrs
Sunday Open : Close : 24 hrs

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:

An accredited agency? Yes    No
Governed by a Board of Directors? Yes    No
A private practice? Yes    No
Funded by the Government? Yes    No


     

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