This form was developed for use by legal guardians. It may also be used by school representatives, Health Care Providers, community partners and anyone supporting a child’s development.
Completing the referral without parental consent is a breach of the family’s privacy. Professionals may support legal guardians in completing the referral if requested.
In addition to the services and programs listed above, physicians and other primary care providers can also refer for assessments for Autism Spectrum Disorder, Neuromuscular Disorder, Global Developmental Delay, Fetal Alcohol Spectrum Disorder, Developmental Coordination Disorder, and Preschool Speech-Language.
Only Pediatricians may refer to the Feeding Clinic.