Referrals

We welcome self, physician, and third-party insurance referrals to our practice. We offer a simple efficient process for referring patients to Impact.

For physician and third-party referrals, please provide as much information as possible on the patient’s circumstances and relevant medical history, to help us identify the best treatment path.

*When we receive a referral, it is important for us to arrive at our own independent diagnosis and treatment plan before commencing treatment.

Referral Form

If you would like to refer a client to us, please complete the following referral form:

Referral Date

Client Name

Client Phone #

Can a confidential message be left at this number?

Can a message be left here?

Yes No

Reason for referral

Current Medications

Referral Name

Referral Phone #

Additional Info

Lesley Sugden, M.A.

Registered psychologist

(403) 829-0818

#320 1716 16th Avenue NW
Calgary, Alberta T2M 0L7