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Child & Adolescent Outpatient Mental Health Services

Forms

Criteria

Services are provided to individuals from the age of six to 17 years old who reside in Kitchener, Waterloo, Wellesley, Wilmot, or Woolwich.

Contact Us

If you have questions or need assistance, please contact:

Phone: 519-749-4300, ext. 3863

Dual Diagnosis Clinic

Forms

Criteria

Please include the required documentation listed in the referral checklist with your referral.

Contact Us

If you have questions or need assistance, please contact:

Phone: 519-749-4310

Psychiatric Consultation Clinic

Forms

Criteria

The clinic provides one-time consultation for patients 18 years of age and older who require diagnostic clarification and treatment recommendations. Patients must reside in Kitchener, Waterloo, Wellesley, Wilmot, or Woolwich. Please review the exclusion criteria listed on the form before submitting your referral.

Contact Us

If you have questions or need assistance, please contact:

Phone: 519-749-4310

Short-Term Psychiatry Clinic

Forms

Criteria

The clinic provides short-term, time-limited involvement for patients 18 years and older who require initiation, adjustment, and monitoring of psychiatric medications. Patients must reside in Kitchener, Waterloo, Wellesley, Wilmot, or Woolwich. Please review the exclusion criteria listed on the form before submitting your referral.

Contact Us

If you have questions or need assistance, please contact:

Phone: 519-749-4310

Specialized Mental Health

Forms

Criteria

Please include the required test results and documentation listed on the form with your referral.

Contact Us

If you have questions or need assistance, please contact:

Phone: 519-749-4310

Provider Information

Mental Health & Addictions Referral Guide

Emergency Cases

If a patient’s condition is life threatening and/or they are highly unstable and/or unsafe, please send them to an emergency department using police or ambulance services if necessary. The process may include:

  • ED physician assessment
  • crisis clinician assessment
  • review with psychiatrist on call
  • disposition as appropriate

Urgent Cases

If same day intervention is required:

  • inquire if your patient has a crisis plan
  • inquire if patient has a therapist/counselor who can be contacted
  • contact Here24/7 at 1 844 437 3247 (Here247) or TTY: 1-877-688-5501
  • contact the psychiatrist on call

Non-Urgent Cases

For non-urgent cases, please fax a completed referral form to 519-749-4271. Forms are available in the sections above. For more information, please call 519-749-4310.