Surrey Clinic location:

Intake Form - Surrey Clinic

Please complete the following intake form to initiate the referral process. Upon receipt, our intake team will contact you within ten days. *Please also check your email junk folder. If you have not heard back from our office within two weeks of the date of submission, please give us a call at 604-584-3450. There may be a wait for assessment or intervention services, our intake team will provide you an estimated wait time when they contact you. Thank you for your patience and we look forward to supporting you.
Address line, City, Province, Postal code
 * Please note, we cannot guarantee the confidentiality of information transmitted through e-mail including this intake form.  If you are not comfortable with this limitation, please contact our office and we will provide an alternate submission method.
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