Name *

First Name

Last Name

Phone *

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Drug Policy *

I understand Cor Sacrum's policy to refer out clients who are using recreational drugs (such as marijuana or THC, etc.). Regulating recreational drug use alongside mental health practice is outside CSCC's scope of practice. Questions? Read our FAQ page

Consent to be Contacted *

I agree to be contacted by Cor Sacrum using and about the information I disclosed in this form.