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Referrals

Whether you are a medical, educational, mental health, or allied health professional, Hexagon Psychology therapists are happy to receive your direct referrals for psychological assessment, counselling, and speech therapy services.

Although our therapists are skilled in a wide range of assessment, counselling, and speech therapy approaches, there may be situations where we would make recommendations to skilled professionals outside of our organization that best suit the client’s presenting needs.

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Consent statement

The client is aware that I am submitting this referral and I have obtained the necessary consent to release information to Hexagon Psychology's staff and professionals.

Referring Provider's Name

Referring Provider's Company

Referring Provider's Email

Referring Provider's Phone Number

Client's Full Name

Client's Email

Client's Date of Birth

Client's Phone Number

In which province or territory does the client reside?

Which service are you referring your client to receive?

Psychological Assessment
Counselling
Speech Therapy

Please provide any relevant background information that may support the psychological assessment, counselling, or speech therapy referral. This information is very useful to our therapists, and ensures an accurate assignment of your client's needs to the proper individual.

Referrals

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