Referrals

If you would like to explore how reachAbility can help you, or if you are a caseworker and would like to make a referral, please complete the form below. This information is required to ensure an efficient intake process. All information collected will remain confidential. 

Inquiries Email: navigator@reachability.org

Please note: Clients will be contacted by reachAbility within 2 business days of receiving the referral.

If you would like to download a copy to fill it out manually and send it to us by fax or e-mail, please down load the form through the button below:

 

 

digital Client intake/referral form

Client Information
Client Preferences
What is your client's preferred method of contact?
Does the client choose to identify as having a disability? *
(e.g. service dog, frequent breaks, enlarged print, etc)
Income Assistance
Is the client on income assistance? *
Case Worker Information
Our commitment is to ensure that case managers are informed of any programs clients choose to attend. Please call (902) 429-5878 for additional information.
Services
(Highlight or control+click as many as you wish)
Does the client have a criminal record? *
Does the client currently receive counselling or other mental health services? *
Is the client medically cleared to work? *
Have you ever been put off work by a doctor due to medical reasons?
Programming
(Highlight or control+click as many as you wish)
Education