Access Point Northwest Application Form

Ontario Structured Psychotherapy Program

The Ontario Structured Psychotherapy (OSP) program provides individuals with publicly-funded, evidence-based, cognitive-behavioural therapy (CBT) and related approaches to help manage depression, anxiety, and anxiety-related conditions.:

Must be 18 years of age or older.

Apply to this service

Case Management Services

Case Management provides support to live in the community and appropriate services by a Case Manager. When referring to Case Management Services, the applicant must:

Must be 16 years of age or older.
Have addiction and/or mental health concerns that seriously affect daily life.
Live within the City of Thunder Bay when service is received.

Apply to this service

Supportive Housing Services

Supportive Housing provides support for persons with mental health and/or addictions concerns. This application form is NOT for non-mental health supported housing. To apply for non-mental health housing, please see the TBDSSAB website. When applying for Supportive Housing, the applicant must:

Must be 16 years of age or older.
Be willing to live within the City of Thunder Bay when service is received.
Be willing to accept some level of support from the housing provider.

Apply to this service

The circumstances below would indicate that you may NOT be suitable for the OSP Program:

I am at high risk to myself, others, or at risk of self neglect.
I am actively suicidal AND have impaired coping skills and/or have engaged in significant suicidal behaviour in the past 6 months.
I am experiencing significant symptoms of mania or hypomania currently or within the past year.*
I am experiencing significant symptoms of psychotic disorder currently or within the past year.*
I have a severe or complex personality disorder that would impact my ability to participate in Cognitive Behavioural Therapy.
I am requesting ONLY medication management.
I have moderate to severe impairment of cognitive function (e.g. Dementia or acquired brain injury) OR moderate/severe impairment due to a developmental or learning disability.
I currently have a problematic substance use or have had in the past three months that would impact my ability to participate in Cognitive Behavioral Therapy.
I have a severe eating disorder that would impact my ability to actively participate in Cognitive Behavioural Therapy.

*This does not include symptoms induced by medication or substance use

I declare that none of the above criteria are applicable to me.

If any of the criteria above are applicable please DO NOT submit the Ontario Structured Psychotherapy referral. Consult with your health care provider or call The Access Point Northwest at (807)-624-3400 for service recommendations.

I declare that the information provided on this application is correct and consent to the collection, use, and disclosure of my personal health information (PHI) with service providers affiliated with The Access Point Northwest. I understand that my PHI may be shared with relevant agencies included with The Access Point Northwest and consent to the access of my medical records relevant to this application.

I consent to the use of email alongside phone to contact me for the purposes of booking appointments and providing intake information. Please see the Consent for Electronic Communication form for further information (filling out this form is not required). (This will make the email address field in the contact section mandatory)

Your Name:

Purpose for Collection and Use of Personal Health Information (PHI)

We collect, use, and disclose PHI only for the purposes of identifying the appropriate service needs as well as:

Collecting relevant information contained in the records maintained by the organizations associated with The Access Point Northwest.
Making referrals to the associated agencies for services, and to fulfill other purposes required or permitted by law.
Sending this application to any agencies that will be providing services.
Disclosing the PHI to a person or organization other than those associated without consent in limited circumstances required by law, such as emergencies of child welfare concerns.
Use of de-identified PHI about applicants to plan and deliver services, for program evaluation, for statistical purposes, and for reporting to our funders.

Privacy Officer

If there are any questions or concerns about privacy, please contact the program manager or our Privacy Officer with The Access Point Northwest at (807)-624-3400. If there are still concerns, please contact the Office of the Information and Privacy Commissioner at 1400-2 Bloor St E, Toronto, ON M4W 1A8, (416) 326-3333.

Fields marked with an asterisk (*) are required.

Purpose for Collection and Use of Personal Health Information (PHI)

Privacy Officer