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
If you are making a referral to tykeTALK Preschool Speech & Language Program (Elgin, London, Middlesex, Oxford) or the Grey Bruce Preschool Speech & Language Program, referrals will be accepted until February 29, 2024 for children who will be registering to begin JK, SK or Grade 1 in the fall.
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 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)
