St. Michael's Homes
262 Gerrard Street East
Toronto  Ontario  M5A 2G2


Phone: (416) 926-8267,
Fax: (647) 493-2432,
Email: info@stmichaelshomes.org
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Referral:
SMHomes Self Referral ID
Date: 2026-10-05 17:53
Status: Draft
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Referral Source
Please tell us how we can help you. Indicate if the issue is related to Addiction, Mental Health, or Both
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Which service are you hoping to access? (select all that apply)
Substance Use Treatment
Aftercare/Out-patient Substance use Support
Our Place (mental health drop-in)
Transitional Housing
Contingency Management
East Hub Day Program
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Salutation
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Does this client have an OHIP card?
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OHIP Card #
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Preferred Language
Please include the area code with phone number. You can provide additional details to the phone number provided in the adjacent comments box.
Client Phone
Phone (Home/Main)
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Phone (Home/Main)
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Alternate Phone
Comments
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Phone (Alt)
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Phone (Alt)
Email Address
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Address
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What is your mother tongue?
If mother tongue is neither French nor English, in which of Canada's official languages is the client most comfortable?
 
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All information is protected under Ontario privacy legislation and is kept confidential.
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