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
At risk for homelessness? | STREET HELPLINE 1-877-848-8481
If you’re thinking about suicide, 9-8-8 is here to help. Call or text 9-8-8 toll-free, anytime.

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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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