Pediatric SLP Referral Form

Practitioners, health care providers, child care workers, and educators, if you are ready to refer a child, please click below to access the referral form for children aged 0-12.

Note: parents can also self-refer by registering online or contacting us.

Do you have a teen patient you need to refer? For SLP services for teens 13+ and adults, call 519-852-9771, email info@connectspeech.ca, or visit www.connectspeech.ca