Online Application

Dear Applicant,

Thank you for contacting the TICP Referral Service. After completing the online therapy application form, please click submit.

We assure you that your application will receive careful consideration and will be held in the strictest of confidence. We will contact you promptly with the name of a therapist who is available to meet with you to assess your needs and provide the treatment you require.

The fee for psychotherapy sessions will be discussed and determined during your first treatment session. We hope it will be possible for us to help you.

Should we be unable to provide the services you need, every effort will be made to connect you with other agencies or individuals who may be able to do so.

Thank you again for using our services

Treatment Application Form

Complete the application for referral form below (online), and click submit when finished. Your form will automatically be forwarded to the TICP Referral Service.

Fields marked with an * are required