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Referral Form

Once we receive a completed referral form, one of our administrative team members will contact you to arrange an Initial Intake appointment.

Please forward referral forms by fax (613) 526-7126, by mail to the Interprofessional Clinic, 1750 Russell Rd., Ottawa ON K1G 5Z6, or in person.


Intake Appointment

This initial appointment may be completed by any of the Clinic’s professionals. It is an intake session to gather relevant medical information and establish client goals that are essential to ensure client driven assessments and interventions.

Also during that first phone contact, the team member may ask you for additional information, or to send ahead forms or documents which will allow you to be better prepared for your first appointment.


Please Bring:

On appointment day, please bring the following information with you:

  • A current medication list (if applicable)
  • Any assessment reports that you have related to the reason for your referral. This could include psychology, school, medical, or other professional reports
  • It is recommended that you be accompanied by a parent or caregiver during the intake session

Upon arrival, hand in any extra documentation that you have brought with you. The evaluation team will meet with you to explain how the clinic works, go through the evaluation process and answer any questions you may have. The evaluation team is composed of at least one of the clinic’s professionals, plus one or more students, representing the same or different professions.

Request an appointment

Someone on our administrative team will contact you by phone as soon as possible.


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    Family Doctor:

    Terms & Conditions:

    I have read and understood the terms and conditions

    I have read and agree with the late arrival and cancellation policy. (Download PDF, 0 KB)

    There are many ways to contact us!

    The Interprofessional Clinic is located within Perley Health. Regular hours of operation are from 8:00AM to 4:00PM.