This Birth to School Start Speech-Language Pathology Referral Checklist (the Checklist) is intended to help child care professionals identify children who may benefit from an assessment of their communication development by a Speech-Language Pathologist. If a child is already known to Niagara Children's Centre, you do not need to complete the Checklist. The cut-off date for the previous Speech documents (updated October 2020) will be February 28, 2024.
To find out more information about the Checklist, referrals, and frequently asked questions check out Niagara Children's Centre's Guidelines in English or French.
Consent Forms are available: pdf or fillable pdf
Also available in French.
Educators may use the Speech & Language Tracking Sheet or the DPS & Speech and Language Tracking Sheet
Birth to School Start Speech-Language Pathology Referral Checklist
Complete ONE age category per child: choose the category that the child has most recently reached.
By 12 Months - English, French
By 15 Months - English, French
By 18 Months - English, French
By 2.5 Years - English, French
By 3.5 Years - English, French
Birth to "School Start" Speech-Language Pathology Referral Form for QCCN: English or French