York Hills Centre For Children, Youth And Families
402 Bloomington Road
Aurora  Ontario  L4G 0L9


Phone: (905) 503-9560,
Fax: (905) 773-8133
Referral Type:
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Referral:
Community Partner Referral ID
Date: 2025-07-27 09:59
Status: Draft
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Hide/ShowCOMMUNITY PARTNER INQUIRY

York Hills offers service to children, youth and their families for children who meet the following criteria:

AGE - 0-17 

LOCATION - the child/youth must reside in York Region

CONCERN - there must be an identified concern regarding their mental health and wellbeing, and they are seeking therapeutic support for this concern.

REFERRAL SOURCE (i.e. agency, organization, professional, etc):
Referral Source:
Worker Name:
Agency:
Phone:
Extension (enter number 000 or 0000 if there is no extension):
Email:
Reason for Referral/Service History:
Reason for the Referral to York Hills:
Previous Services Accessed:
Is the family aware that you are referring them for service at York Hills?
Do you anticipate any barriers to the family accessing service, if so what additional supports may be needed?
Have you received verbal or written consent from the family to provide us with their contact information?
(if written please upload to referral form)
If needed, would you prefer to be contacted by phone or email regarding this referral?
By Phone
By Email
Documentation - has there been, or will there be, any assessments, reports, letters sent to YH?:
Has this child/youth or family ever used York Hills' services before?
(including Blue Hills and York Centre)
Yes
No
Custody/Parenting Order:
Intact Family - No Agreement
Separated Family?
"if separated/divorced, please indicate if there is a formal agreement or informal agreement as well as whether the caregiver has sole custody/decision-making or shared custody/decision-making:
Identified Client:
First Name
Last Name
DOB
Select Date Clear Date
Age Years Months
Gender
Gender Identity:
Parent/Caregiver(s):
Client Contact Info:
Phone #:
Who does the phone # belong to?
Permission to call?
Email:
Other Children?:
Names/Ages:
Family Race/Ethnicity/Cultural Identity?:
Address (York Region?):
Postal Code
?
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