Make a Referral – Aphasia Institute

A referral may be made by:

Individuals with aphasia, or their family members, friends, and others
Health Care Professionals: Speech-Language Pathologists, Physicians, Social Workers, Care Coordinators, and others

Please send forms in via email, using our PHIPPA-approved email address:

aireferral@onelineconnect.com

Fax is still accepted: 416-226-3706

Referral Forms

Standard Referral Form

For individuals who have aphasia, due to stroke, brain injury, brain illnesses, and other acquired conditions.
Ideally, a Speech-Language Pathologist (SLP) will complete this referral form.
An SLP Assessment report must accompany this referral
Ensure the consent form on page 3 is completed prior to submission of the referral form.

Aphasia Institute Standard Referral Form Download

Primary Progressive Aphasia Referral Form

For individuals who have been diagnosed by a Medical Doctor with Primary Progressive Aphasia.
Ideally, the Medical Doctor or a Speech-Language Pathologist will complete this referral.
Medical reports must accompany this referral.
If available, please attach any SLP Assessment and Progress reports
Ensure the consent form on page 3 is completed prior to submission of the referral form.

Aphasia Institute PPA Referral Form Download

After the Referral is Made: What to Expect

After the referrral has been received:

An acknowledgement of receipt will be sent by email.
The applicant will be contacted by an intake worker to discuss our programs.
If the applicant is interested, an assessment will be scheduled to determine whether our programs will meet the applicant’s needs.

Referral agents, please continue to support us by sending in your fully completed referral forms along with necessary reports (see above) to enable us to ensure a smooth and quick intake process.