Penticton Referral – Pediatric

Pediatric Referral (Penticton)

  • Using this referral form, please provide as much information as possible about the child you're requesting services for. If you are NOT the legal parent or guardian, please fill out the section below:
  • Parent/Guardian (if not entered above)

    If you're not the child's legal guardian, please provide their legal guardian's information below:
  • Child's information

  • DD slash MM slash YYYY
  • In order to accommodate new referrals, our therapists need to consider travel times to and from scheduled sessions. If you are flexible about your child's session location, you may be able to start services sooner.
  • When there is a waitlist in place at your local Meridian clinic, therapists from other Meridian clinics may be able to provide services sooner via Zoom-Telehealth Sessions
  • Please let us know if you have funding through a third-party source (ex. Autism Funding, At Home Program, schooling, etc.), or if you plan to pay privately
  • Please provide any information that will help us establish your child's services. You can include things like; your child's diagnosis/s, history of their previous therapies, things you'd like their Meridian therapist/s to address, etc.
  • (i.e. mornings/afternoons/Mondays/etc.)
  • This field is for validation purposes and should be left unchanged.
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