Online Application – old

Treatment Application Form

Dear Applicant,

thank you for contacting the TICP Referral Service. The application fee is $25.00. This fee is charged to offset administrative costs. Please click the button below, to proceed to the online payment service, a secure payment site where you can pay for the referral service by credit card.


If you incur problems with the button, please try another browser or contact the website administrator here.

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.

Our therapists are not covered by OHIP and therefore the fee for psychotherapy sessions is 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.

Kadri-Ann Laar, Ph.D, C.Psych., Chair
99 Post Rd., Toronto, ON M3B 1J3
Naomi Stein, MA
TICP Referral Service Committee