Professional Referrals

Appointments for assessment and treatment can be arranged by professional referral (i.e., from a family doctor, a psychiatrist, a lawyer, a rehabilitation consultant, etc.). Referrals are not required, however, and clients may contact the admin team at Let It Go Psychological Services directly at 289-351-1706 to arrange for an intake. Questions or inquiries may be sent via email to info@letitgopsych.com.

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Referring Professional

Please enter your information in the section below. Client information will follow in the bottom section of the form.

Name

First Name

Last Name

Phone

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Fax

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Email Address

Client Info

Please enter your client's information below.

Client name

First Name

Last Name

Date of birth

Best phone number to contact client

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Another way to contact client

Brief description of presenting problem: