Teacher Referral Form Logo
  •  - -
  •  -
  •  -
  • We are a virtual-first clinic with secure video sessions available across Ontario, along with some in-person options. Our specialized multidisciplinary services and integrated treatments involve allied health professionals are not covered by OHIP. Fees may be covered by private insurance.

  • Area of Concerns have been observed in the following areas:

  • Teacher/School Information

  •  -
  •  -
  • I acknowledge that I have received consent from the family of the above-named student to share this information with the Possibilities Clinic.

  • Clear
  •  - -
  •  
  • Should be Empty: