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Healthcare Provider Information Form
Stay in the know!
To get information and updates on the Ontario Structured Psychotherapy (OSP) program, please provide your contact information.
*
1.
First & Last Name
(Required.)
2.
Email Address
3.
Would you like OSP materials sent to your office? (e.g., patient facing postcards, posters etc.)
Yes
No
4.
What materials would be of most interest to you? Check all that apply.
Postcards for patient self-referral
Brochures for patient self-referral
Posters for waiting/clinical rooms
Tear-away notepad for patient self-referral
Information sheet for health care provider referral
5.
Please include your address for OSP materials to be delivered.
6.
We are reviewing how the OSP program communicates with PCPs and referral sources.
Please assign a level of importance (
5 being most important and 1 being least important
) to each of these communication points during the client’s journey in OSP.
1
2
3
4
5
Patient has been referred to program (if PCP is not the referral source).
1
2
3
4
5
Patient’s triage decision following assessment (notifying you of which OSP service they will be receiving).
1
2
3
4
5
Patient is transferring from one OSP service to another – usually a ‘step-up’ from a less intensive service to a more intensive service.
1
2
3
4
5
Patient has exited the program.
1
2
3
4
5
OSP is not suitable for the patient (usually sent with recommendations for other services and when possible we will redirect the patient).
1
2
3
4
5