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Nurse Practitioner Led Clinic 60 Bond Street West, 2nd Floor Oshawa, Ontario Tel: (905) 4369945Referral to the Nurse Practitioner Led Clinic PATIENT INFORMATION First Name ___ Sex ___ Health Card
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How to fill out Canada CMHA Durham Referral to the Nurse Practitioner Led

01
Obtain the Canada CMHA Durham Referral form from the official CMHA Durham website or local office.
02
Fill out your personal information at the top of the form, including your name, contact details, and date of birth.
03
Provide relevant medical history and any current health concerns that you wish to discuss with the Nurse Practitioner.
04
Indicate the reason for the referral in the designated section, explaining the specific support or treatment needed.
05
Include information about any previous treatments or services you have received.
06
Add any additional comments or concerns that may be relevant to your health care.
07
Sign and date the completed form to verify that the information is accurate.
08
Submit the form to the designated CMHA Durham office, either in person or via email/fax.

Who needs Canada CMHA Durham Referral to the Nurse Practitioner Led?

01
Individuals experiencing mental health challenges who require assessment and support from a Nurse Practitioner.
02
People who have previously engaged with CMHA services and are seeking continued mental health care.
03
Patients needing a transition from other health services to specialized mental health support.
04
Individuals seeking preventive mental health care and wellness services.
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The Canada CMHA Durham Referral to the Nurse Practitioner Led is a process that allows individuals to access mental health services provided by Nurse Practitioners within the Canadian Mental Health Association (CMHA) Durham.
Individuals seeking mental health services or their healthcare providers are required to file the Canada CMHA Durham Referral to the Nurse Practitioner Led.
To fill out the Canada CMHA Durham Referral, individuals need to provide personal information, details about their mental health concerns, and any relevant health history. This form can typically be obtained from CMHA Durham services or their website.
The purpose of the referral is to facilitate access to mental health care services, ensuring that individuals receive appropriate support and intervention from Nurse Practitioners.
The information that must be reported includes the individual's name, contact information, description of mental health issues, previous treatments, and any current medications or therapies being used.
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