Referrals

Our staff will answer your questions to see if we can help.

You can also complete one our referral forms and drop it off at our Centre. Please click on the links below:

Referral for Children’s Treatment Centre of Chatham-Kent

• Referral Form (English)
• Formulaire de référence

School Based Rehabilitation Services:

• School Based Rehabilitation / Central Auditory Processing Services Principal Referral Form (English)
• Services de réadaptation en milieu scolaire Formulaire de recommandation de la direction d’école

Please attach the appropriate checklist to the service you are requesting from below, and attach to the Principal Referral Form completed from above:

Physiotherapy Checklist

• Physiotherapy / Occupational Therapy Teacher Checklist – Please print off document complete and forward to the CTC-CK.
• Formulaire de recommandation de la direction d’école

Occupational Therapy Checklist

• Physiotherapy / Occupational Therapy Teacher Checklist – Please print off document complete and forward to the CTC-CK.
• Liste de vérification du personnel enseignant – ergothérapie

Speech Therapy Checklist

• SLP Referral Form
• Recommendation de l’orthophoniste du conseil scolaire

Central Auditory Processing

• Auditory Processing Domains Questionnaire (APDQ) completed by teacher – Please print off document complete and forward to the CTC-CK.
• CAPD Teacher Checklist
• Traitement auditif central – Liste de vérification du personnel enseignant

Coordinated Service Planning (CSP)

Referral from community service provider: English Form

Formulaire d’Aiguillage Vers la Planification Coordonnees des Services de Chatham-Kent: French Form

Augmentative and Alternative Communication (AAC) Clinic

Please read the Augmentative Communication  Clinic (AAC) Information on Services and Referral Services (Part 1) for more detailed information.  The following forms must be completed:

• • • (Part 2) – Request for Augmentative and Alternative Communication (AAC) Clinic Referral Form
    • (Part 3) – Augmentative and Alternative Communication (AAC) Guided Assessment-Daily Communication Partners Form (Must be completed and included with referral)

Fetal Alcohol Spectrum Disorder Program (FASD)

Referral from community service provider:  English Form

Fee For Service

• • Fee For Service Information
    If you are interested in finding out more about Fee for Service Occupational Therapy and Speech/Language Therapy, please call Marnie Ball, 519-354-0520, ext. 243.