Welcome Form Welcome-Form I am * Required An individual looking for services or information A family member or loved one A professional looking to make a referral or for information Other Please use the referral form located at the link below Intake Referral Form 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.