Centre Labelle Centre - Service Request - Assessment Services

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Submit a service request

Fill out the form below to submit a request.

First and last name

Phone number

Email

You wish to apply for:

an assessment

a consultation

You wish to apply for:

yourself

your child

You prefer to be contacted by:

phone

email

Age of the person concerned:

Reason for reference / Other comments

Thank you for your submission!

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