ReFocus You Referral Form. Name * First Name Last Name Phone * (###) ### #### Email * Main Reason For Referral * Treatment Type Individual Therapy Couples Therapy Family Therapy Children's Therapy Tele Therapy Virtual Reality Therapy Workshops (Kinder - Gr.12) Workshops (Businesses) Assessments Motor Vehicle Accidents Thank you! Contact UsPlease contact our admin staff for any questions or concerns. Thank you Phone(780) -700-2577Emailadmin@refocusyou.ca