CCAS Referral
Note: If this is regarding an urgent matter, crisis, or a current inpatient needing to be seen on site, you will need to speak directly with a clinician before arrangements are made.
Our Services are Free, Confidential, and are Offered on a Voluntary Basis
For information on our services offered, catchments area and target population etc. please view/print our agency brochure.
Instructions
A referral may be made by the person that is requesting service or by a friend, family member, doctor, social worker, etc. as long as that person is aware and agreeable to the referral.
For your convenience you may print out the referral form below and submit it either by mail or fax. For legibility purposes, please print information only.
Please attach any pertinent additional information/documents such as: probation information, release of information form, as well as any background information relevant to case management such as violence or sex offender/victim etc.
Northern residents are usually seen through Nodin Counselling, however, under certain circumstances they are seen by our agency and therefore will need to have a short screen interview with one of our clinicians before any arrangements are made.