Mental Health Service Referral Form
CICS Newcomer Mental Health Program

** Kindly be aware that the CICS Newcomer Mental Health Program does not offer crisis intervention services and, as a result, cannot accept referrals for emergency support.
** Our counselling service is available to newcomers 16 years of age and older.
  • Part One / Client Information

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  • Part Two / Referral Information

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  • Part Three / Reason for Referral

  • Part Four / How did you know about the CICS Mental Health Program?

  • Thank you for the referral!
    For further inquiries, feel free to reach out to us at 416-292-7510 Ext. 1127 or email us at