UPDATE YOUR SERVICE PROFILE



Enter the following about your organization and/or service. When you are finished, click "Submit Service".

Your service will not appear immediately on the site. southwesthealthline.ca staff will review the information submitted.

Information displayed in the coloured cells below are not mandatory to enter.

Notes
Orange - Information entered in the orange fields does not appear on the public site. It is used by health care professionals for planning and/or data management purposes.
Green  - Information entered in the green fields also does not appear on the public site. It is displayed to health care providers for information and referral purposes to assist clients.





Canadian Mental Health Association - Oxford County Branch
Service Name:
Level 1:   
Level 2:   
Level 3:   
Level 4:   
Level 5:   
Former Name:   
Phone Numbers: Office:   
Toll-Free:   
TTY:   
Crisis:   
After Hours:   
Fax:   
Email:   
Website:   



Mailing Information: c/o:         Street Address: (if different)
Building:   
Address:   
City:   
Province:   
Postal Code:   
Room:
Intersection:
Accessibility:
Accessibility Notes:
Hours:
Dates Available:



Executive: Name:   
Title:   
Organization:   
Phone:   
Email:   
Executive 2: Name:   
Title:   
Organization:   
Phone:   
Email:   



Public Contact: Name:   
Title:   
Organization:   
Phone:   
Email:   
Public Contact 2: Name:   
Title:   
Organization:   
Phone:   
Email:   
Provider Contact: Name:   
(if different) Title:   
Organization:   
Phone:   
Email:   
Description:
Meetings:
Provider Notes:






LHIN Funded:
Funding:
Fees:
Application:
Application Notes:
Target Population/Eligibility:
Age:
Minimum:    Maximum:  
Languages:












French
Language Note:
Area(s) Served:
Year Established:
Legal Status:



YouTube Video #1 URL:   
Title:   
YouTube Video #2 URL:   
Title:   
YouTube Video #3 URL:   
Title:   



Please ensure that you include your name, email address and telephone number in case we need to contact you to confirm your changes.
Source: Name:  
Title:  
Organization:  
Phone:  
Email:  
Comments:



Types of Changes Submitted:

       
 



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