Make a Referral

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Make a Referral

Contact and Referral Information

To initiate services, please complete the appropriate referral form below and submit it to our Centre.

If you are not sure which service would meet your needs, call the CTC-CK at 519-354-0520, ext.0 and we would be happy answer questions and provide information to help you choose the right service. 

Referrals can be submitted electronically, by fax, mail, email, or phone. 

Electronically:

  • Open the appropriate referral form, complete the form electronically,  click on the Submit button located at the top of the form

Manually:

  • Download the appropriate referral form
  • Complete electronically or print a copy and complete
  • Email the completed form: info.forwarding@childrenstreatment-ck.com
  • Fax: 519-354-7355
  • Mail: 355 Lark St, Chatham, ON, N7L 5B2

Phone:

  • Call the CTC-CK at 519-354-0520, ext. 0 and we will be happy to help with your referral.

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

Physiotherapy

Speech Therapy

Central Auditory Processing

Coordinated Service Planning (CSP):

Referral from Community Service Provider

Augmentative Communication Services (ACS) Clinic:

For detailed information and consultation requests, please refer to the following documents:

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.