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  • For mental health or addictions information, support or crisis services contact Reach Out at 519-433-2023 or 1-866-933-2023.

CMHA Middlesex

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Welcome Form

Welcome Form

  • Name * Required
  • Address
  • What time do you prefer to be contacted?
  • What can we help you with? * Required
    Please select all that apply.

If it is easier for you, you can also download this Welcome Form Fillable PDF and then fax or scan/email it to our Intake Team. Email to info@cmhamiddlesex.ca or fax to 519-438-1167.

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