Refer a Counsellor to MembersHealth
To ensure you can keep seeing the same trusted therapist through your MembersHealth benefits, you can refer your counsellor to our network. This helps you maintain continuity of care while also giving other members access to high-quality professionals who understand and support the unique needs of our =community.Please note: Referral does not guarantee acceptance. We will carefully review all applications and do our best to move promising candidates through the process.
Referrer Information (You)
Full Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Organization
Counsellor Information
Counsellor’s Full Name
First Name
Last Name
Practice/Clinic Name (if applicable)
Counsellor’s Email Address
example@example.com
Counsellor’s Phone Number
Please enter a valid phone number.
Office Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Details
Type of Services Provided (e.g., individual therapy, couples counselling, trauma support):
Professional Designations/Qualifications (if known):
Why are you referring this counsellor?
Consent
Submit
Should be Empty: