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 Referral Form - required
Preschool Speech and Language (PSL) Form - also required if referring a preschool aged child for Speech and Language concerns
Physicians Making a Referral
TVCC 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 Referral Form* - required along with the appropriate discipline** form(s)
