Sunbeam Developmental Resource Centre
205-1120 Victoria Street North
Kitchener  Ontario  N2B 3T2


Phone: (519) 741-1121,
Fax: (519) 743-4730

Plexus- A Network of FASD Supports and Services in our Community: Client Referral Form

Please complete this form to make a referral to Sunbeam Developmental Resource Centre. We offer clinical assessment, consultation and support services to individuals who have a developmental disability and/or an autism spectrum disorder, and to their family and support agencies. There is no fee for the individual user.

Eligibility:

The services of Sunbeam Developmental Resource Centre team are available to individuals of any age who have a developmental disability and/or an autism spectrum disorder.

A referral in the child/youth name can be made by the individual or their legal guardian. SDRC will also accept referrals from extended family members, family physician, or any agency acting on the individual’s/family’s behalf as long as permission to do so has been provided by the individual or their guardian.

The consent of individuals 16 years of age or older who are able to understand the implications of assessment/treatment is required when facilitating a referral on their behalf.

If you have concerns or questions about our agency’s policies regarding eligibility for children, under 18 years of age, please contact our Clinical Intake Worker. Eligibility for adults, 18 years or older, is determined by Developmental Services Ontario.

What Happens Next?

After receiving a completed referral form in the child/youth name and the required supporting documentation verifying eligibility for SDRC services, you will receive a Referral Confirmation letter by mail or email within 2 to 4 weeks. This will be followed by contact from an Intake worker to arrange an initial Intake Appointment. The wait for an appointment can vary depending on referral volumes and may take up to 4-6 months.

If you have not received a Referral Confirmation letter from us after 4 weeks, please call 519-741-1121, so that we can avoid any unnecessary delays.

Thank you for your referral to our agency. We look forward to working with you.

Child/Youth Referral
Child/Youth Information
Select Date
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Child/Youth's Address
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Client (if 16 years of age or older) is aware of and has consented to this referral to SDRC. If No, Referral can not be accepted:
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Other Email:
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Attachments
1. If you would also like to make a referral for services from Sunbeam Developmental Resource Centre, please upload documentation that provides an assessment letter/report regarding a diagnosis of an Autism Spectrum Disorder and/or an Intellectual Disability. A letter simply stating a diagnosis without providing supporting assessment information is not sufficient to confirm eligibility for SDRC services.

2. For referrals to Plexus Network of FASD Supports and Services, referrals can be made with or without a diagnosis of FASD.

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All information is protected under Ontario privacy legislation and is kept confidential.