Psychiatry and Mental Health

All referral forms on this website are also available as eForms for OSCAR, Avaros, Indivicare, and ACCURO EMRs. You can download some of the premade forms here from WorldOSCAR or fill the contact form below for any other eForms that are not listed for your EMR.

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London

London ResourcesServicesLocationFormContactInformation
Adult London & Middlesex Mental Health Coordinated Intake (Age 18-64)1. Urgent Psych Consultation Service
2. General Adult Ambulatory MH Services
3. Trauma Stress Service
4. Addictions
LHSC – Victoria Hospital
St Joseph’s Hospital
New:
There are 2 separate forms for urgent and non-urgent referrals.

PDF form: ADULT (18-64) NON-URGENT AMBULATORY MENTAL HEALTH AND ADDICTIONS REFERRAL FORM

OSCAR eForm

PDF form: ADULT (18-64) URGENT CONSULTATION SERVICE (UCS) MENTAL HEALTH AND ADDICTIONS REFERRAL FORM

OSCAR eForm
Phone: 519-667-6777
Fax: 519-667-6685
Email
Fax Consult
Website
Prevention and Early Intervention Program for Psychoses (Age 16-35)1. PEPPLHSC – Victoria HospitalLHSC PEEP ReferralPhone: 519-667-6777
Fax: 519-667-6657
Email
Fax Consult
Website
Urgent Psych (LHSC ER, SJ UCC, Strathroy ED  ONLY)1. Urgent PsychiatryLHSC – Victoria HospitalLHSC Urgent Psych Referral

LHSC Urgent Psych Patient Handout
Phone: 519-685-8500 EXT 75521
Fax: 519-667-6836
ED Clerk to Book Appointment & Fax Consult
Patient to get date & time of appointment
Website
Geriatric Psychiatry1. Geriatric Mental Health
2. Geriatric Community Outreach
Parkwood HospitalGAAT Referral Form (Outpatient)Phone: 519-685-4046
Fax: 519-685-4020
Fax Referral for centralized intake
Please call Access Office they are happy to discuss referrals
Website
Pediatric Psychiatry1. Pediatric PsychiatryLHSC – Victoria HospitalLHSC Pediatric Psych Referral
LHSC Pediatric Psych Full Patient Package
Phone: 519-667-6640
Fax: 519-667-6814
Fax Consult
Patient/Parent to fill in package and send to intake
Website
Dr. Templeman, David1. Pediatric Psychiatry151 Pine Valley Drive
London, ON N6J 4M2
0-5 years old
6-13 years old
14-17 years old
Phone: 519-435-6499
Fax: 1-866-504-3115
Fax consult form
Pediatric Eating Disorders1. Pediatric Eating DisordersLHSC – Victoria HospitalLHSC Pediatric Eating Disorders ReferralPhone: 519-685-8500 EXT 56334
Fax: 519-685-8595
Fax Consult & Investigations
Website
Pediatric Psychiatry Emergency Diversion Clinic (for internal referral from ER)1. Urgent Child and Adolescent Psychiatry ConsultationLHSC – Victoria HospitalEDC Patient Email & Phone Consent Form
EDC Fax Cover Page
EDC Patient Handout
Phone: 519-667-6640
Fax: 519-667-6814
To refer to the EDC on call, patient must complete the email & phone consent form, then fax it along with the ER assessment using the EDC Fax Cover Page to 76814. The family will then by contacted for their intake appointment and the psych consult will be over OTN.
InnerWorks CounsellingCounselling for:
Perinatal mental health, Substance use, Trauma, Anxiety & depression, Teens, Parent coaching
6-4562 Colonel Talbot Road,
Upper Level
London, ON
N6P 1B1
Phone: 226-400-4330
North Counselling and PsychotherapyCounselling for:
Adults, Teens, Kids, Parents
Anxiety, Depression, Trauma, Grief, Relationship Issues, Life Changes
First Responders and active and Veteran members of the Canadian Armed Forces

Psychoeducational Assessments for teens and kids
119 Wortley Road
Suite 7
London, ON
N6C 3P3
Referrals can be made through our website at www.northcounselling.ca by clicking “Get In Touch”Phone: 519-200-4376Website: www.northcounselling.ca
Email:  [email protected]

St. Thomas Elgin & Oxford County

St.Thomas Elgin & Oxford County ResourcesServicesLocationFormContactInformation
St. Thomas Elgin Adult Psychiatry1. Adult PsychiatrySt Thomas Elgin General HospitalSt. Thomas Elgin Psych ReferralPhone: 519-637-0511
Fax: 519-631-6497
Fax Consult
Website
Woodstock Hospital Psychiatry
1. Dr. Amanullah, Shabbir (Adult)
2. Dr. Ferreria, Sharon (Adult)
3. Dr. Ismail, Aden (Child & Adolescent)
1. Adult Psychiatry
2. Child & Adolescent Psychiatry
Woodstock HospitalGenericPhone: 519-421-4223
Fax: 519-533-6972
Fax Consult
Website
Oxford-Elgin Child & Youth Centre1. Child & Adolescent Mental Health
2. Walk in Counselling
912 Dundas Street
Woodstock, ON
N4S 1H1
99 Edward Street
St. Thomas, ON
N5P 1Y8
121 Thames Street North
Ingersoll, ON
N5C 3C9
1 Library Lane
Tillsonburg, ON
N4G 4W3
*Call or Walk In*Phone: 1-877-539-0463
Email
Website

Huron Perth

Huron Perth ResourcesServicesLocationFormContactInformation
HPHA Psychiatry – Dr. Chahal, Raman; Dr. Broad, Kathleen1. Psychiatry & Mental Health ServicesStratford General HospitalStratford (HPHA) Psych & Mental Health ReferralPhone: 519-272-8210
Crisis Line: 519-274-8000
Fax: 519-272-8226
Fax Consult
Website
Huron Perth Seniors Mental Health1. Seniors Mental Health ServicesHuron Perth – HPHAHuron Perth Seniors Mental Health ReferralAlzheimer Society Huron:
P: 1-800-561-5012
F: 519-482-8692Alzheimer Society Perth:
P: 1-888-797-1882
F: 519-271-1231HP Senior Mental Health & Addiction Response Team
P: 519-527-8421 x 4821 / 4818
P: 519-272-8210 x 2570
F: 519-527-8420
F: 519-272-8184SW CCAC (LHIN)
P: 1-855-276-3400
F: 519-273-2847 
Fax Consult to Appropriate Agency
HPHA Eating Disorders1. Eating Disorders (Ages 13-18)Stratford General HospitalStratford (HPHA) Eating Disorders ReferralStratford (HPHA) Eating Disorders BrochurePhone: 519-272-8210
Fax: 519-272-8226
Fax Consult & Investigations
Website
Huron-Perth Centre1. Child, Adolescent & Family Mental Health63 Lorne Ave E Unit 2A
Stratford, ON
N5A 6S4
73 Wellington
Clinton, ON
N0M 1L0
570 Main Street W
Listowel, ON
N4W 1A8
*Call or Walk In*Crisis: 1-888-829-7484
Stratford:
P: 519-273-3373 x2221
F: 519-273-0892Clinton:
P: 519-482-3931 x3221
F: 519-482-9251Listowel:
P: 519-291-1088 x4221
F: 519- 291-9850
Website

Form 1 & 42 with Schedule 1 Facility List

FormServicesLocationsFormContactInformation
Form 1 & 42 *Call Hospital to Transfer*Schedule 1 Hospitals
LHSC – Victoria Hospital Children’s Hospital London Health Sciences Centre
St Thomas Elgin General Hospital
Woodstock Hospital
Stratford General Hospital
Alexandra Marine and General Hospital (Goderich)
Form 1 & 42Phone
LHSC: 519-685-8500
St. Thomas: 519-631-2030
Woodstock: 519-421-4211
Stratford: 519-272-8210
Goderich: 519-524-8323

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