Submit a referral for the Health Department Infant & Child Development Program

Durham Region’s Infant & Child Development Program is a free program available to families who have concerns about their child's development.

Services offered to children between the ages of birth to school entry and who are living in Durham Region may include:

Informal and formal assessments.
Parent coaching and modeling.
Activity ideas to support the child’s daily routine.
Assistance accessing resources and community services.
Occupational therapy consultation.

Durham Region Health Department recognizes that the use of email is a commonly used and preferred form of communication.

By using this form, you acknowledge and understand:

You are agreeing to be contacted by email.
Sharing of personal and/or personal health information via email should be kept to a minimum.
Any personal and/or personal health information that you provide to us via email will only be used to respond to your message and/or provide you with the requested information.
While steps are taken to protect the privacy and security of emails, sending and receiving emails over the internet is not secure. We cannot guarantee the security of any messages sent or received.
You may withdraw your consent to the use of email at any time by contacting us.
Do not use email for emergency or urgent health care matters.

Parent/Legal Guardian information

First name

Last name

Primary phone number

Email address

Address (include unit/apartment number if applicable)

City

Postal code

Child information

Child's legal first name

Child's legal last name

Child's date of birth

Child's sex

Female

Male

Unknown

Prefer not to answer

Referring agency information

First name

Last name

Phone number

Extension (if applicable)

Referring agency (if applicable)

Personal and Personal health information is collected under the authority of the Child, Youth and Family Services Act, 2017 and the Personal Health Information Protection Act, 2004. This information is collected for the purposes of assessing, planning, implementing and evaluating programs and services available to children from birth to school entry who have a developmental disability and/or risk of developmental delay. Questions about the collection and use of this information should be addressed to the Manager, Health Information, Privacy and Security: Durham Region Health Department, at 605 Rossland Rd. E., Whitby ON L1N 0B2, 905-668-7711.