Private Health Referral

The Paragon PsychConnect Team has psychologists, counsellors and a mental health occupational therapist that can work with you to assist you in developing strategies to manage various psychological conditions both individually or in a group program.

Please complete the form below and we will contact you to discuss your needs.

Once you complete the form and press “Submit Referral Form”, the form will be sent to us and emailed to you as an attachment.

Alternatively, you can fax or ring our office to make an appointment.

If you cannot complete the online form below, please go to Referral Forms to download a pdf form that you can fill in, and either email it to us or bring it with you, to assist us with your initial appointment.

Referral Form Private Health
  • Client Details
  • Submit Form

Private Health Referral Form

Client Details

Client Title
Client Address *
Client Address