Caregiver Coaching Program: Self-Referral Form

To be considered for the Caregiver Coaching Program, all questions on this form must be answered to the best of your ability.

After the form is filled out, a member from our Caregiver Support Team will reach out within 3-5 business days to schedule a 30-45 minute intake over the phone.

Please note, we work with each caregiver directly during the intake process to see if Caregiver Coaching is a good fit for their current needs. Caregivers may be referred to other services or support.

If you require any assistance with the self-referral form or have any follow-up questions, please email us directly at helpline@ontariocaregiver.ca