Mood Disorders Association of Ontario
2300 Yonge St
Suite 1600 Unit 17
Toronto  Ontario  M4P 1E4


Phone: (416) 486-8046,
Fax: (416) 486-8127
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Referral:
One-on-one Peer Support and Counselling Intake ID
Date: 2026-11-06 12:32
Status: Draft
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We offer short-term structured one-on-one counseling and peer support over the phone or online through a virtual platform. Please register below and a team member will follow up within approximately 4 weeks for the initial intake. Please contact us at intake@hopeandme.ca if you do not hear back from us within 4 weeks.

If you are in crisis or need immediate assistance, please contact a crisis service such as the Gerstein Crisis Centre (416-929-5200), 911 or visit the emergency department of a hospital.

Which service are you interested in?
Peer Support (Peer Support: One-on-one)
Counseling (Family - Family Matters Peer Support and Recovery Program)
 
Date
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First Name
Last Name
Date Of Birth
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Gender
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Address:
Street Number and Name:
City
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Postal Code
Phone (Home/Main)
Is this a private number so that it's safe to leave a voice mail from Hope + Me?
E-mail address
Preferred time of contact (days and times)
Presenting Concern:
Are you currently engaged in Peer Support at Hope + Me?
(If applicant replies YES, please fill in next question)
If yes, please also provide the name of the applicant's Peer Support Worker in the text box below.
Additional Information
 
Please note: Standard Referral Source is Self, Family, or friend
Referral Source
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