Referral Information

To access our services you can contact us directly by phone at 613-722-3222, by fax at 613-722-4652 or by using our on-line referral form.

A referral from a physician is not necessary, however most extended health insurers require a physician referral for reimbursement.

Referral Form

Client Information:

Referral To: General Dr. Tammie Ricci, C.Psych.
Client Name:
Client Address:
Client City:
Client Province: NFLD NS PEI NB PQ ONT MAN SASK ALTA BC YT NWT NVT
Client Postal Code:
Client Home Phone:
Client Work Phone:
Client Cell Phone:
Client Date of Birth
Can we leave a message at the client's home? Yes No
Can we leave a message at the client's workplace? Yes No

Referral Information

Referral Name:
Referral Address:
Referral City:
Referral Province: NFLD NS PEI NB PQ ONT MAN SASK ALTA BC YT NWT NVT
Referral Postal Code:
Referral Work Phone:
Referral E-Mail:
Notes: