Eligibility and Referral Forms
General Eligibility Criteria
- A resident of the communities of Hamilton or the larger HNHB LHIN if unable to access service closer to home.
- We will visit all LTC facilities in the communities of Hamilton.
- Home visiting catchment is West of Ottawa St. & West of Upper Gage Ave. in Hamilton.
- Age 65 years or older (under 65 years if experiencing difficulties usually associated with aging such as, Parkinson’s or Dementia).
- Not currently under the care of a Geriatrician elsewhere.
- Patient / Substitute Decision Maker consenting to referral.
- Family Physician (or other MD/NP) completes and faxes referral.
- Patient would benefit from one of our services.
Clinics, Outreach, and BSO - click HERE to download the referral form.
OTs 2 Go - click HERE to download the referral form.
Note: Replace above linked Referral Form with:
IMPORTANT CHANGE IN SERVICES for OTs2Go: As of February 1, 2018, the OTs2Go Program will no longer accept referrals for scooter assessments. We will continue to provide assessments for walkers, manual wheelchairs, power wheelchairs and seating. A list of private ADP authorizers can be obtained from the Assistive Devices Program at 1-800-268-6021.
Call Our Intake Coordinator: