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Get In Touch

A member of our team would be happy to answer any questions you may have. Feel free to call, email, or stop in our location to get in touch.

Visit Us

When you book an in-person appointment it will be at our new Alta Vista location. Give us a call if you have any questions.

1815 Alta Vista Dr, Ottawa, ON K1G 3Y6

admin@cafco-ceafo.ca

Tel: 343-588-1842

Fax: 343-588-1841

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Request for Services

Children

Adolescents

Initial Appointment Request - Children

Province which you reside *

City *

Service type *

Family Status *

-- Assessment --

-- Treatment --

-- Group Therapy--

Language *

Location *

Your name *

Client name (if different from above)

Client date of birth

Client school(if applicable)

Phone number with voicemail *

Email address *

Do you have insurance? *

Does your insurance cover: psychologist? *

Does your insurance cover: social worker? *

Does your insurance cover: speech-language pathologist? *

Referral Source *

Add Reason for referral/presenting problem *

Other requests or pertinent information?

By checking this box I hereby authorize the the Child, Adolescent, and Family Centre of Ottawa (CAFCO) to communicate with me via the means provided above regarding the services I am requesting. I also understand that CAFCO does NOT use email addresses or any other electronic addresses for commercial/promotional purposes as understood by Canada's Anti-Spam Legislaton (CASL).

Initial Appointment Request - Adolescents