Children's Treatment Network Referral Form

Client Information

Parent or Guardian Information

Collection and Sharing Consent

Youth/Family agree with this referral including the collection and sharing of information for the purposes of processing referral

Program Requested

For more detailed information on the Programs listed here, including a list of required supporting documentation, please visit

If you have supporting documentation, please fax to 705-792-2775, and indicate this in the above field.

If you have any questions or need assistance completing this referral, please contact ACCESS at 1-866-377-0286.