Make a Referral
Make a Referral
Contact and Referral Information
If you have questions or need assistance in understanding our services, our helpful staff is just a call away. Dial 519-354-0520 and press 0, and we’ll be more than happy to assist you!
Services Overview:
Not sure about which service suits your needs? Our staff can answer your questions and guide you through our offerings to find the best fit for you.
Referral Forms:
To initiate services, please complete the appropriate referral form below and submit it to our Centre.
General Referral for Children’s Treatment Centre of Chatham-Kent:
School-Based Rehabilitation Services:
SBRS Principal Referral Form (Must be completed and attached to appropriate program checklist below.)
Occupational Therapy
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Occupational Therapy Teacher Checklist
Download -
Occupational Therapy Teacher Checklist – French
Download
Physiotherapy
Speech Therapy
Central Auditory Processing
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Auditory Processing Domains Questionnaire (APDQ)
Download -
CAPD Teacher Checklist (English)
Download -
Traitement auditif central – Liste de vérification du personnel enseignant (French)
Download
Coordinated Service Planning (CSP):
Referral from Community Service Provider
- Download
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Formulaire d’Aiguillage Vers la Planification Coordonnée des Services de Chatham-Kent (French Form)
Download
Augmentative Communication Services (ACS) Clinic:
For detailed information and consultation requests, please refer to the following documents:
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Augmentative Communication Service Referral Questionnaire
Download -
Augmentative Communication Service Consultation Request
Download
For ACS consultation requests, please email the completed form to mball@CTC-CK.com or contact us at 519-354-0520 for further assistance.
Fetal Alcohol Spectrum Disorder Program (FASD):
Referral from Community Service Provider:
Client Funded Services:
For information regarding Purchased Services for Occupational Therapy and Speech/Language Therapy, please contact Marnie Ball at 519-354-0520, ext. 243.
Thank you for considering the Children’s Treatment Centre of Chatham-Kent. We look forward to assisting you on your journey.