Referral Portal Referral Orginator* First Last Referring Organization*Referrer Email* Client* First Name Last Initial Client's Occupation*For group programs, public safety personnel and civilians will be enrolled in separate cohorts.Client's Date of Birth* YYYY MM DD Client lives in which province?*British ColumbiaOntarioClient is interested in:* Virtual group trauma therapy Client is interested in:* Virtual group therapy for trauma Virtual group therapy for problematic substance use Virtual group therapy for anxiety and/or depression Individual therapy Diagnostic assessment Employment situation:*Working, no accommodationsWorking, with accommodationsOn leaveHow can we help?*Please upload password protected files (.pdf only) here and send password to info@borealwellness.com Drop files here or Accepted file types: pdf. CAPTCHA
