How to make a referral to KidsInclusive

General referral form

Currently we require a physician referral for medical services. We respectfully ask that the referring physician forward all pertinent medical reports along with the referral form to help accelerate the referral process.  

*Please note that a Pediatrician referral is required for the Feeding Clinic*

General Referral Form – Word

General Referral Form – Fillable PDF

Augmentative communication services

Referrals to Augmentative Communication Services (ACS) are accepted from parents, physicians, therapists, or community service providers with parent’s consent. For a detailed description of the program please click on the title in the menu on the right-hand side of the screen.

Referral Form – Augmentative Communication Services

If your child has previously been seen in the Augmentative Communication Service for face to face communication or writing aids and their device is no longer meeting their basic communication needs at home, please fill out the corresponding re-referral form below.

Face to Face Re-Referral Form

Writing Aid Re-Referral Form

Autism services

Social ABC program offered through the Caregiver Mediated Model of the OAP, can be accessed by families who have been invited to the program through the OAP. Call 1-855-544-3400 ext 2078 for more information.

Urgent Response Service referrals can be made y families or service providers for children/youth who are registered with the OAP.

OAP URS Referral Form – Word

OAP-URS-Referral-Form – Fillable PDF

**Please note: URS is NOT a crisis intervention and does not respond outside of business hours and the child/youth being referred for URS must be registered with the OAP.

Developmental Assessment referrals should use the Medical and Therapy referral form and must be made by a physician.

COORDINATED SERVICE PLANNING

KidsInclusive|EnfantsInclus – KHSC is the Coordinating Agency for children and youth with multiple and/or complex special needs and their families in the Service Delivery Areas of Kingston, Frontenac, Lennox & Addington, and Lanark, Leeds & Grenville. Together with service partners in education, health care, developmental services, child protection and other child and youth serving community agencies, we are committed to supporting families in a more seamless service experience across multiple providers.

Service Planning Coordinators will work with other service providers and if appropriate, directly with families of children and youth with multiple and/or complex special needs to support a coordinated, family-centred service experience.  A Single Plan of Care may be developed for the child/youth which takes into account all of his/her goals, strengths, needs, as well as all of the services that the child/youth is be receiving.

 Coordinated Service Planning includes:

• A clear point of contact so families know where to go when they have questions
• A coordinated plan responsive to the child/youth’s goals, strengths and needs
• A family-centred process that puts the child/youth and family at the centre of the plan and the planning process

CSP Referral – Child and Family Review (Fillable)

Additional Information for Families and Professionals

Please use our online referral form by clicking here.

Families, family doctors, and or child care providers may make a referral to Early Expressions Preschool Speech and Language Program. By making a referral to this program, you are requesting a speech and language assessment by a speech-language pathologist.

If you are unsure if a referral is needed, please review Communication Milestones for the child’s age or call Early Expressions at 613-544-3400 ext 3175 and press 3.

FETAL ALCOHOL SPECTRUM DISORDER (FASD) WORKER

KidsInclusive|EnfantsInclus – KHSC is pleased to host two Ministry of Children and Youth Services funded FASD Worker positions – one for Kingston, Frontenac, Lennox & Addington and one for Lanark, Leeds & Grenville.

FASD Workers support families of children and youth with FASD by leading the development of a strengths based support plan for children/youth with FASD or suspected FASD.  The FASD worker will work with the family, service providers and educators to build capacity for supporting the child/youth up to the age of 18 (or 21 if still in school) in family, school and community life.

Referral Form – KidsInclusive FASD Worker

Feeding Clinic referrals are only accepted from a pediatrician. Medical issues as they relate to feeding (medications, reflux, gastric delays/ constipation, oral structural anomalies, allergies, congenital anomalies and/or other medical issues associated with feeding difficulties) are first assessed by the pediatrician prior to making a referral to Feeding Clinic. Please see the Feeding Clinic page for details.

We respectfully ask that the referring physician forward all pertinent medical reports (Growth chart required) along with the referral form to help accelerate the referral process.

For any inquiries related to feeding referrals, please call the System Navigator at ext. 2078

Feeding Clinic Referral Form – Word

Feeding Clinic Referral Form – Fillable PDF

School Based rehabilitation services

Anyone, including parents or guardians, teachers, physicians or other health care professionals can refer to the School Based Rehabilitation Services. For a detailed description of the program please click on the title in the menu on the right-hand side of the screen.

Referral Form – KidsInclusive School-Based Services

OT/PT Additional Information Form for Referral

SLP Additional Information Form for Referral