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



Contact Phone Number

Marital Status:

Parent 2 (First and Last Name)

Email Address

Home Phone Number

Child's Name

Child's Age

Street Address


Postal Code

Presenting Issue(s) :

Services Requested :

Please add any additional information

Referal Source