NEED HELP? 905-451-2123 or 1-877-451-2123 | IN CRISIS? 24.7 Crisis Support Peel Dufferin 905-278-9036 or 1-888-811-2222 

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Intake Form: Mental Health and Addictions Registration

For immediate access to mental health and addiction services, please call 905-451-2123. Due to higher than normal volumes, responses to online submissions are taking longer than normal.

If you would prefer to use the fillable PDF version of this intake form, please click here. If you choose to use the downloadable PDF, please save it to your computer, complete the form, and then email it to

Inquiries: 905-451-2123

Registration Form

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