This form was developed for use by parents and legal guardians.

Primary health care providers, community partners, school representatives or anyone else supporting the child’s development and/or supporting the parent/caregiver may also complete the form.

Professionals can use the tool to complete a referral with and/or on behalf of a parent/legal guardian. Completing the referral without parental consent is a breach of the family’s privacy.

1. Complete this online service request, typically taking 5-10 minutes.
2. The final page will allow you to book an intake appointment on the spot. If you do not wish to book right away, you may refer without booking & will receive a confirmation email with a link to book later.
3. Once completed, you will receive a confirmation email.
4. If you require an interpreter, you will be contacted directly by our Intake department to schedule the intake call and will not receive the initial confirmation email.
5. During the intake appointment call an Intake Social Worker will help identify and connect your child & family with the services that best fit the needs of your child.

1. Complete this online service request, typically taking 5-10 minutes.
2. Once completed, the parent/legal guardian will receive a confirmation email. Email for parent/legal guardian is required.
3. From the confirmation email parent/Legal Guardian will have the opportunity to book an Intake Appointment directly.
4. During this intake call an Intake Social Worker will help identify and connect the family with the services that best fit the needs of the child.

If you need a LANGUAGE INTERPRETER or other assistance to complete this form, please call the SmartStart Hub at KidsAbility at 519 886 8886 ext. 1214.

If you are able to complete this form but will require an interpreter for the intake call, this can be arranged & requested while completing this form.