All fields are required unless marked “optional”
Services are provided for children with Physical or Developmental Disabilities, impairments with Communication, Hearing or Vision. Family must live in the catchment area of service.
Please visit our website at https://www.erinoakkids.ca/ for detailed eligibility criteria and questionnaires where indicated.
Please be certain to check criteria for referral to ADRS on the website. If client does not meet eligibility criteria, please refer to
community services (i.e. Preschool speech and language services, school board, etc.)
If client is picked up for service and they do not meet eligibility criteria, they will be discharged from ADRS. They may be rereferred for service up until their 18th birthday.
Note: If technology is only needed at school, please follow up with your school for service options (e.g. Special Education Resources, School Health Support Services).
First 2 boxes must be checked for referral to be processed
Required only for Medical Services or OHIP Pediatric Physiotherapy Clinic
Do you need more time to complete the referral?