Intake & Referrals

We offer a wide range of services for children and youth. Although anyone can make a referral, some services do have specific referral criteria. Feel free to contact us to talk about you/your child's needs and we’ll help you get started.

Note: If your child receives services through HVPI (Home Visiting Program for Infants at CPRI) and you have concerns around communication or feeding, please contact your Parent Infant Therapist to discuss speech, language and feeding supports.

Note: If you are looking for services for a child less than 2 years of age with developmental concerns, please refer to Developmental Resources For Infants (DRI)

Make a Referral

You can request services in 3 ways: using our secure online referral form, by mailing/faxing, or by calling us.

Option 1 - Secure Online Referral Form

The online form you will complete is encrypted, and meets all requirements for protecting health care information.

Online Referral Form

Option 2 - Downloadable Forms: Mail/Fax Your Referral

Download, print and complete the PDF referral form and fax it to TVCC at 519.685.8705 or mail to TVCC, 779 Base Line Road E., London ON N6C 5Y6 Attention: INTAKE

DOwnload Forms

Option 3 - Call Us to Refer

Speak with an Intake Coordinator at 519.685.8716 (in London calling area) / 1.866.590.8822 ext 58716 (toll free) OR 1.866.590.8822, Press 1 for Autism and Behavioural Services.

Information Collected

What information we collect and what we do with it:

We collect the information from you to check that you/your child is eligible for our services and to prepare to do an assessment. We will also use the information to contact you about an assessment or to get more information. We keep your information secure and private. Find out more about about our privacy practices.

Request a Report

Clinical reports can be obtained with the consent from the client, parent or legal guardian. Please send requests along with corresponding consent to:

Clinical Information Services
779 Base Line Road East
London, ON N5C 5Y6
Fax: 519.685.8705

If you need more information about requesting a report, please call 519.685.8716