If you’d like to make an appointment:


For either Telephone Consultation or Face to Face Consultation please fill in the whole Self-Referral Form.

The Clinical Director will contact you within two working days of receiving your Self-Referral form to set an appointment time. There is a fee for all consultations (most counseling fees are covered by third party insurance plans). There is a 48-hour (2 business days) cancellation Policy for all appointments or fee is billable. You can fill out one of the contact forms and mail to RMPS at #220, 1509 Centre St. SW, Calgary, Alberta or use the emailable Self Referral Form below.
You can call directly to book an appointment.

Self Referral Form

 

Date

Contact Phone Number

Marital Status:

Parent 2 (First and Last Name)

Email Address

Home Phone Number

Child's Name

Child's Age

Street Address

City

Postal Code

Presenting Issue(s) :

Services Requested :

Please add any additional information

Referal Source