We want to get to know a little about you to help us support you. You do not need to complete all of the following boxes. Only fill out what you think would be important for us to know. Feel free to answer with short, point form answers.
We want to find out how we can support you. You do not need to complete all of the following answers. Only fill out what you think would be important for us to know. Feel free to answer with short, point form answers.
Service or Treatment History
Medication History
Family/Friend/Support Person’s Information
*The following questions are asked because we offer family/friend support through our Family Educator. We also collect this information in the case of emergency. You will have an opportunity to answer questions below about how we will use this information.
If you would like to refer yourself to the Youth Wellness Centre but do not feel comfortable with the online process, please contact the Youth Wellness Centre at 905-522-1155 ext. 31725