Community and Service Provider Referrals
"North Hastings Children's Services provides quality services and supports to enhance the well being of children and their families in partnership with our community"

Please complete this form if you wish to refer a client or family to any NHCS services.  Please find more information about the services available at www.nhcs.ca.

After completing this form we will reach out to yourself and or the client directly as indicated in your request.

For more information please contact the NHCS Executive Director, Jessica Anderson at janderson@nhcs.ca. 
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Requesting Organization *
Person Requesting  *
Position of Person Requesting *
Contact Information of Person Requesting *
Have you discussed this referral with a NHCS team member? If so, who?
What program would you like to refer the client/family to?  (for more details on programs please see the appendix links on our website at www.nhcs.ca/contact) *
Reason for the referral *
Client Name (please indicate if parent or child/youth) *
Age or DOB of client *
Address or Municipality *
Contact name and relationship if different than client
Client Contact Information for Referral  *
Please check off the relevant information
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