Referral Form

Please Note:


  • The referral form can be completed by either a client, caregiver, health professional or educator with permission from the client/caregiver.
  • Our referral form incorporates our Privacy and Confidentiality Statement + Consent to Obtain and Release Information form as part of our commitment to protecting your privacy.
  • If you run into issues with this online referral form you can contact our office to complete a referral over the phone.
  • At certain times throughout the year we may have waiting lists for particular regions. To find out if there are waiting times in your region please contact the office.