Please click the button below and complete our request for service form.
Our team will review your request and an available therapist will be matched based on your identified need.
You will be contacted by the Registered Social Worker Therapist to schedule the initial consultation which is provided at no cost.
Direct Billing Form
Client Satisfaction Form
SYMPTOM SCREENING TOOL
REQUEST FOR SERVICE FORM
Connect with us.
COVID SCREENING FORM
Request for Service Form
CONNECT WITH US
INSURANCE & FEES
CLIENT SATISFACTION FORM
CLIENT CONSENT FORM
530-3336 Portage Avenue Wpg,Mb R3K 2H9
+1.2042537072 • firstname.lastname@example.org
TELUS HEALTH DIRECT BILLING
electronic transmission authorization and consent form
Confidentiality and the overall Security of our clients is our top priority. In order to maintain excellence in this area our therapists operate within the Jotform platform.
Copyright © Mobile Social Clinic Inc. All Rights Reserved.
IF YOU ARE IN A LIFE THREATENING SITUATION- DO NOT USE THIS SITE CALL 204-940-1781 OR 911
HIPPA & SECURITY
View on Mobile