Community Mental Health & Addiction Services
Walk-In: Mon, Wed & Fri 1–4 p.m. (807) 683-8200 Français

Rapid Response Request for Services Form

For individuals 16 years of age and over who need immediate, short-term support due to issues related to mental health and/or problematic substance use.

Preview only — this online form is not connected yet. Call (807) 683-8200 or visit during the walk-in hours.

Personal Information
Psychiatric History
Authorization

The applicant is aware and has given consent to submitting this document and wishes to be considered for the services provided by Alpha Court.

If an individual has assisted the applicant with this document please complete the following: