Candidates’ Referral Request Form
The TICP Referral Service Committee was established to make psychoanalytic psychotherapy and psychoanalysis more accessible to the community at large by decreasing both the waiting period and the fees for therapy sessions. At the same time, the Referral Service is intended to facilitate the training of candidates by providing them with patients and control cases. We are therefore encouraging you to complete the enclosed Candidates’ Referral Request Form and to update it periodically.
We are also inviting you to become familiar with the application process outlined on our website and to advertise the service among your colleagues and acquaintances. We welcome your questions, comments and suggestions.
Looking forward to hearing from you
TICP Referral Service Committee
Deborah Levine, interim liaison
Click on the button below to download the form. Complete the form and send it back by scan/email or fax: