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Request for Services

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

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).

Unfortunately, due to high demand, our Wait List is currently closed and we are not accepting new clients at this time.

Please check back in Early Fall. We look forward to welcoming new clients again soon.

In the meantime, please also connect with these resources:

https://www.cafco-ceafo.ca/resources/

www.ementalhealth.ca

https://walkincounselling.com

Database for Ottawa specific Psychologists https://ottawa-psychologists.org

Currently accepting new child and adolescent clients: https://socialsciences.uottawa.ca/centre-psychological-services-research/

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