Application To Concurrent Disorder Support Services (Cdss)
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4Concurrent Disorders Support
Services Application Form
Instructions for Application
Concurrent Disorders Support Services (CDSS) is a partnership of over 35 agencies working together to provide a
range of specialized short-term supports to persons with concurrent disorder (both mental health and substance use)
and other challenging issues.
CDSS takes referral from medical and community-based organizations operating within the City of Toronto. CDSS
reviews the client’s current needs, negotiates service with the referral source and refers to a partner or external agency.
CDSS offers a high degree of support to access, navigate the system and attend these services and provides fast-tracked
entry to persons in need. After referral to a partner service, CDSS checks back with the provider to see if additional
services are needed.
Who does CDSS Serve?
Any person over 16 years of age.
With co-occurring mental health disorder and active substance use issues.
And having other challenges affecting social welfare, such as homelessness, disability, trauma, ,etc.
While CDSS encourages referral through clients’ service providers, so as to continue existing case facilitation, we
do work with those who are currently unattached. CDSS does not, however, provide urgent or emergency service.
How Do I Apply?
Fax the CDSS Application Form and signed Consent Form to CDSS at fax: 416-364-8526.
Within two business days, CDSS will call you to negotiate service and refer to the agreed service provider.
For information, call CDSS at 416-644-3081, ext. 365 or ext. 394 or email
See the Fred Victor website to download referral and consent forms.
Concurrent Disorders Support Services Client Treatment Consent to the
Collection, Use and Disclosure of Personal Information
To protect your privacy, CDSS follows the Ontario Personal Health Information Protection Act.
To provide you with service, CDSS needs your consent (agreement) to collect, use and disclose your personal
information for the following purposes:
Coordinate your care and services among current, referring and partnering agencies.
Determine your eligibility (from your application form and possible meetings).
Assess your needs, based on your own information, information from your current or referring agency and
information from diagnostic, hospital or agency reports.
Develop service and discharge plans.
Refer to other agency services in the partnership that meet your request for service.
Refer to services outside the partnership that you agree meet your needs.
Contact you or leave messages, either directly or through persons/ organizations that you list on your application
form. (Please do not include any names/ places you do not wish us to call.)
Provide information for program development, research and evaluation. Please note that information used for
these purposes will not identify you.
“The policies in this consent form have been explained to me. I have had an opportunity to discuss them and ask
questions. I consent to these policies during the period in which I am waiting for or receiving service or until I no
longer wish service.”
Client name: ___________________________________________________ Date (D/M/Y): ____________________
Client signature: _________________________________________________________________________________
Concurrent Disorders Support Services at Fred Victor
145 Queen Street East, Toronto, Ontario M5A 1S1
Hours: Monday to Friday, 9AM -4 PM
Tel: 416-644-3081 Exts. 365 / 394; Fax: 416-364-8526
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