YOUTH INTAKE FORM

Please take the time to fill out our clinic intake form before your first appointment. 

Have you had direct contact with any social agency or mental health professional (psychologist, psychiatrist, social worker) in the past?
Are you currently taking medication?
Have you taken medication in the past?

989 Eglinton Avenue West. Suite #1

Toronto, ON M6C 2C6

The COPE Clinic

Child and Youth Psychology

© 2019