Online Referral to KidsAbility

Change log

2025-03-17 robv: adding updates for Professional requests; removing HCCSS Transfer & OEYC Transfer options (moved to primary care specific roles as OHaH & EarlyON); fix province, same address mapping 2024-11-15 molly: updated consent on page 5, changed confidentiality statement to policies & procedures and updated hyperlink 2024-10-03 robv: contact info page, add calculations to enable 'same address as child' to map actual addresses to Legacy for both parents
2024-08-21 robv: toggle on 'Hide from answers dataset' for page 2 calculations group. Fix placeholders on addresses, add postal code mask. 2024-07-23 robv: add OEYC Transfer option & logic

Welcome to the Online Referral Form for KidsAbility.

KidsAbility is a SmartStart Hub for Waterloo Region, City of Guelph, and Wellington County. We provide a range of therapy services to children and youth aged birth to 18 (or until age 21 if attending a publicly funded school in our area).

As a SmartStart Hub, we support and connect families with concerns related to their child’s development and day-to-day functioning. Depending on a child or families’ needs, services may be provided by KidsAbility or by other community Partner Agencies.

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.

Who should complete this online referral form?

As a SmartStart Hub we can support families with concerns about their child’s development who:

  • Are not sure what their child’s development needs, what services to seek or are not sure where to start.
  • Feel they would benefit from a discussion about their child’s development/strengths/needs.
  • Feel they would benefit from referral(s) to appropriate services, and access to family education and family supports.

Primary care providers/physicians, community partners, other professionals or someone helping a parent or guardian fill out the form may also submit the online referral form on behalf of a child/family with their consent.

  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.

To Begin:

calculations

KidsAbility uses 'parent' (legal guardian & Form Helpers), and 'professional' (primary care provider, school rep)
'yes' only for Provider/EarlyON referrals
Not showing Service dropdowns on pg 2 if EarlyON or H4K is selected in the 2nd role dropdown
Used on Referral info page to word the question nicely
Used in multiple places so only need to update it here