S.L.Hunter & Associates

Referrals are accepted directly from clients, caregivers or other professionals. Feel free to contact us by:

       Phone: (905) 637-5522

              fax: (905) 637 4995

   or email: slhunter@bellnet.ca

We also have 2 electronic referral options:

Client Referral Form:

Name:

Address:

Home Phone:

i.e. 905-555-5555

Work Phone:

Ext.

Cell Phone:

Date of Birth:

(i.e. dd/mm/yyyy)

Age:

Referral Date:

(i.e. dd/mm/yyyy)

Referral Source:

Parents:

School:

Reason for Referral:

Notes:

Has The Client Received Previous SLP Services?

Yes: No:

Availability:

Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
AM: PM: Both:	AM: PM: Both:	AM: PM: Both:	AM: PM: Both:	AM: PM: Both:	AM: PM: Both:

Have you read and agree to the fee schedule? Yes: (Click Link to read Fee Schedule)