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Ontario Autism Program Urgent Response Services - New Client Intake Request

All fields are required unless marked “optional”

*Important* - This is not a crisis line. If this is an emergency, please call 911.


This request is being submitted with the knowledge and consent of named parents/legal guardians. Have parents provided implied consent to information collection as per ErinoakKids Privacy Policy available at:

Ontario Autism Program (OAP) Registration Confirmation

Is the child currently registered with the Ontario Autism Program (OAP)?

Client Information
Parent / Guardian / Family Information
Primary Person to notify (primary contact – will be the only person notified for services)
Next of Kin (secondary contact - optional)
Special Needs Information
Referral Source

Do you need more time to complete the referral?