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Mental Health Intake Form

The current wait times following the completion of the intake process is approximately 3 months.

MENTAL HEALTH INTAKE PROCESS

Once you submit the Mental Health Intake Form a Mental Health Intake Worker will call you as soon as possible to complete a screening appointment. This is not a counselling appointment; it is a 20-minute screening appointment to assess your primary concern and identify which resources best meet your current needs and make referrals as deemed appropriate.

RFHT offers structured, short-term clinical services to those individuals ages16+ experiencing challenges in their life. Our focus is to educate and motivate individuals towards developing goals and skills that will support their mental and emotional well-being.

Please remember that clinical services do not allow space to support complex/long-term support/services. Clinical services are through a Trauma-Informed Lens that is not long-term treatment. Mental health intake screening assesses if a client’s needs fit within the scope of RFHT counselling services. Appropriate referral suggestions may be offered as part of the intake process.

ACCESSING OUR SHORT-TERM COUNSELLING SERVICES (MAX 8 sessions)

RFHT has limited resources to be able to continue to provide free access to counselling services. Therefore, if a client does not require all 8 sessions within a 6-month time frame, the client will be discharged from mental health services. Clients who require counselling in the future are able to request an intake assessment 18 months from their last session.

Click here to complete and submit Mental Health Self-Referral Intake Form

Physical Health

Mental Health

Present Situation

Counselling objectives

Preparing for the appointment

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Common Psychosocial and Emotional Concerns Appropriate for Referral

•Anxiety-related concerns (e.g., generalized anxiety, social anxiety, health anxiety)

•Depressive symptoms and mood disturbances

•Panic attacks and acute anxiety episodes

•Grief and bereavement support

•Adjustment difficulties related to life transitions or unexpected change

•Stress management and coping skills development

•Occupational and workplace-related stress or burnout

•Family-related stressors and conflict resolution needs

•Social isolation and difficulty maintaining support networks

•Emotional dysregulation and difficulty managing strong feelings

•Relationship challenges (e.g., interpersonal conflict, communication breakdowns)

•Low self-esteem and self-worth issues

•Identity or self-concept concerns

•Anger management difficulties

•Trauma-related symptoms (if appropriate or to direct elsewhere)

•Motivation and goal-setting challenges

•Difficulty adapting to new environments (e.g., school, work, relocation)

Please be aware that the infomation you provide will be included in your chart and accessible to our Social Work team. This helps us better understand your needs and provide you with the best possible care and support. We want to assure that all the information you provide will be used solely for the purpose of your care.

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The Rapids Family Health Team is a non-profit organization proudly funded by Ontario Health and the Ontario Ministry of Health and Long-Term Care. We partner with the province to deliver high-quality, compassionate, and collaborative primary care to our community.
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Contact Us
Pontiac Drive (Main Site)
1150 Pontiac Drive, Suite 4,
Sarnia, Ontario
Tel. 519-339-8949
Access to Care Centre
481 London Rd. (Inside London Road Diagnostic Centre, 1st floor),
Sarnia, Ontario
Tel. 519-491-6188
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After Hours Care
481 London Road (1st floor beside pharmacy), Sarnia, Ontario
Tel. 519-491-6188