Service Request

SmartStart Hub

by Surrey Place - Intake

Program Eligibility

I am requesting services

First name of the client

Postal code

Calculations

[age-years]

[age-bucket]

Age months calculations

[months-text-en]

(no need for months-text-fr, its always 'mois')

[age-months] : Age (months)

[years-text-en]

[age-months-this-year] : Age (months)

[postal-1st-character]

Eligibility calculations

Eligibility calculation for each Service on the next page

[eligibility-audiology]

[eligibility-acwa]

[eligibility-behaviour-therapy]

[eligibility-bmacke]

[eligibility-caregiver-mediated-early-years]

[eligibility-coordinated-service-planning]

[eligibility-developmental-therapy]

[eligibility-down-syndrome-clinic]

[eligibility-entry-to-school]

[eligibility-extensive-needs-services]

[eligibility-fasd-diagnostic-assessment]

[eligibility-fasd-service-coordination]

[eligibility-occupational-therapy]

[eligibility-parent-enhancement-program]

[eligibility-plus-45]

[eligibility-physiotherapy]

[eligibility-psychiatry]

[eligibility-psychology-services]

[eligibility-service-coordination]

[eligibility-social-work]

[eligibility-speech-and-language]

[eligibility-preschool-speech-and-language]

[eligibility-smart-start-hub]

[eligibility-tre-add]

[eligibility-symphonic]

Pronoun & wording calculations

Registrant ASD pronoun (capital Your)

"Your child has", "You have" or "The child has"

Registrant pronoun lower case

"your child", "you" or "the child"

Registrant my pronoun lower case

"my child", "myself" or "the child"

Registrant pronoun upper case

"Your child", "You" or "The child"

[Child's information title]

"Your", "Your child/youth/adult" or "The child/youth/adult"

Calculations for documentation

Launch org id

Launch service id