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
Carefully review the list of forms below to
choose the form(s) appropriate for your situation.
Self-refer my Child/Youth or Community Referral
TVCC Self Referral Form - required
Preschool Speech and Language (PSL) Form - also required if referring a preschool aged child for Speech and Language concerns
If you are referring to the Grey Bruce Preschool Speech & Language Program or the tykeTALK Preschool Speech & Language Program (Elgin, London - Middlesex, Oxford counties), referrals will be accepted until February 28, 2025. This is for children who will start school (public, private, or homeschool) in fall 2025 and were born in 2021, 2020, or 2019.
If you have any questions about eligibility criteria, please contact an Intake Coordinator at 519.685.8716 (in London calling area) or 1.866.590.8822 ext 58716 (toll free).
Physicians Making a Referral
TVCC Physicians Referral Form- required
PABICOP Supplementary Form* - also required if referring for Paediatric Aquired Brain Injury Community Outreach Program (PABICOP)
Refer for School Therapy Services
TVCC STS Referral Form* - required along with the appropriate discipline** form(s)
