Making a Referral - Forms

To make a referral for services, please download and complete the following forms.

1. Referral Information Sheet
2. Informed Consent to Referral and Prelimary Assessment
3. Consent to Share Information
4. Past History Checklist
5. BEST (Basic Eligibility Screening Tool)

The completed forms may be faxed to: (519) 421-4249 or mailed to:

Regional Support Associates
293 Wellington St. N.
Woodstock, Ontario
N4S 6S4

attention: Jayne Joyes

For further information or assistance, please call:

Jayne Joyes, Senior Administrative Assistant
(519) 433-7238 ext. 2212 or
1-800-640-4108 ext. 2212