THÉLA PSYCHOTHERAPY CLINIC · PROFESSIONAL REFERRALS

Professional referral inquiry.

For hospital discharge teams, case managers, physicians, psychiatrists, and community professionals seeking scheduled outpatient psychotherapy for children, adolescents, or adults. Inquiries are welcome before or after discharge.

Privacy and clinical safety: This is a planning template, not a live secure referral service. Do not enter identifiable patient details or protected health information until Théla has configured and approved a secure submission workflow. This form does not send information to Théla. For emergencies, call 911 or use emergency services; for suicide crisis support in Canada, call or text 988.

Referring professional

Referral overview

Clinical fit and continuity

Primary support needs *
Existing care supports

Authorization and next steps

Before submitting a referral

* Required fields. Client name, birth date, health card number, diagnosis documents, discharge summaries, and risk details are intentionally excluded from this preliminary inquiry template.

Théla reviews suitability and availability before accepting any referral. Referring providers remain responsible for appropriate discharge arrangements and follow-up until care is formally established. Return to outpatient psychotherapy information.