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Ontario Structured Psychotherapy - Culturally Safe eReferral

Do you wish to self-identify as First Nations, Inuit, or Metis? *This question is required.This is voluntary and we ask every participant.  We ask because we offer a culturally safe pathway to First Nations, Inuit, and Métis peoples. This includes enhancements to various aspects of the OSP program to increase relationship building, safety, equity and ensure high-quality care for Indigenous peoples. Participants within this pathway will work with therapists who have received specific trainings in relation to the delivery of psychotherapy to Indigenous peoples. The Culturally Safe pathway was developed collectively with the OSP CMHA Indigenous Advisory Circle. We also may be able to connect you with culturally relevant services offered in the community. Asking also helps us understand how many Indigenous participants access our services so we can ensure that there are important services available for Indigenous participants. If you self-identify as First Nations, Inuit, or Metis, you will receive the same access to psychotherapy services and have the opportunity to connect with culturally relevant supports. If you self-identify, your clinician will follow up with you and make a virtual or in person appointment to meet. Please also bring any questions you might have about this to your first meeting.
Please note that this pathway is designed and intended for First Nations, Inuit, or Metis individuals only. For all other individuals, please use the Ontario Structured Psychotherapy Self-Referral Form to submit a referral.
Are you 18 years of age or older? *This question is required.
Please Note:
This program is designed to support patients 18 years of age or older.
For Youth services, please visit Mental Health and Wellness Services for Indigenous Children and Youth
There are a few questions we have, to make sure we can get in touch with you.
This question requires a valid date format of MM/DD/YYYY.
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Please provide at least one method of contact: *This question is required.
Preferred method of contact: *This question is required.
There are a few ways to connect with our clinician. Please select how you would like to proceed: *This question is required.
Please select availability for a therapist to call you:
(Morning times can be between 8-11AM, and Afternoon times can be between 1-4PM) *This question is required.
Permission to leave a voicemail: *This question is required.

Please Note 

This form contains Personal Health Information (PHI). By submitting this form, you are consenting to the use of your PHI by CMHA York Region Ontario Structured Psychotherapy Program for the purpose of processing a referral. 

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