Refer a Client
(for healthcare providers/lawyers/insurers)
Name of Person Referring
Email of Person Referring
Phone Number of Person Referring
Please note we require the following information to activate a client's profile in our electronic booking system; if this is not available at time of referral, please kindly forward to firstname.lastname@example.org as soon as available.
Name of Person Being Referred
Phone Number of Person Being Referred
Email of Person Being Referred
Please upload any relevant background information/referral documentation.
Please provide additional background on the Referral Request.
Please share enough information that can help Dr. Samra make a clinical match (e.g. presenting concerns, demographics, work/disability status, ongoing/pending claim details) as well as ideal time frame for booking an intake session).
We'd love to know how you heard about our practice!
Please note that Dr. Samra is not directly taking referrals, but has a team of excellent clinicians who all work under her Registered Psychologist treatment supervision and oversight - our clinicians are Master’s level counsellors & CBT Therapists, and given Dr. Samra's supervision the vast majority of our services are covered by extended health benefits.
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