Membership

Membership at Clubhouse requires a referral from a professional connected to the field of mental health. The individual can be any of the following:

• Family Physician / General Practitioner
• Registered Nurse
• Psychiatrist
• Psychotherapist
• Occupational Therapist
• Social Worker
• Clinical Social Worker

Note: The referring professional is required to fill and sign multiple parts of the member application form.

A filled 5-page member application form is a required before an interview. The form can be filled out digitally via third party software, but given its complexity and need for multiple signing parties, we recommend filling the form out on paper.

The following information about the prospective member is required in our application form:

• General Name/Address information
• General medical history
• Mental health diagnosis information
• Medical, Psychiatric & Community Contacts
• Referring Medical Professional
• Substance Abuse History
• Legal History

Note: Clubhouse all reserves the right to request histories or reports from hospitals, agencies, etc. to assist us in our determination of suitability for membership.

Download: Member Application Form

Note: This form will need to also be filled out by a referring professional. See details above.