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Home
About Us
Our Team
Newsletters
Acquired Brain Injury
Survivor Stories
Survivor Profiles
Annual Reports
Sponsors and Supporters
Awards
Programs
Programs Info
Lidz on Kidz
Brain Connect
>
Device Program
Tech Talks
Tech Guides
Testimonials
IPV Program
Young Brain Circle
Weekly Support Groups
Peer Support Program
Caregivers
Art Therapy Programs
>
Unmasking Brain Injury
Acrylic Paint Pouring
Fused Glass
Mugs
Gupta Exhibition
Events & News
Events & News Info
News
Upcoming Events
>
A Moment in Time
Past Events
>
Winter Sports Helmet Giveaway
BIAWW Picnic
BIAWW Walk, Run and Roll 2022
BIAWW Walk, Run and Roll 2021
Lidz on Kidz 2022
Lidz on Kidz 2021
Greeting Cards
Lidz on Kidz 2020
Oktoberfest Warm-Up 2019
Comedy Night 2019
Oktoberfest Warm-Up 2018
Comedy Night 2018
Resources
Resources Info
COVID-19 Update
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Referral Form - "Care to Share" Care Giver Support Group
*
Indicates required field
Referral Source
*
ABI Consultation Service
CCAC
Family
Self Referral
Brain Injury Association of Waterloo-Wellington
Traverse Independence
Hospital (Please name below)
Other (Please specify below)
Name of Hospital if chosen above
*
Specify Other if chosen above
*
Name
*
First
Last
Address
*
City
*
Postal Code
*
Home Phone Number
*
Alternative Phone Number
*
This may be a cell number or your work number.
Work Extension #
*
Email
*
How do you want us to contact you
*
Home Phone Number
Alternative Phone Number
Email
Who has the Acquired Brain Injury
*
Husband
Wife
Child
Sibling
Parent
Location you desire
*
Kitchener
Guelph (Wellington County)
Cambridge
If we are currently in session do you want to be put on a waitlist
*
Yes
No
Have you attend a Care to Share Support Group through the Brain Injury Association of Waterloo-Wellington before
*
Yes
No
If you have attended before please supply an approximate date
*
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Home
About Us
Our Team
Newsletters
Acquired Brain Injury
Survivor Stories
Survivor Profiles
Annual Reports
Sponsors and Supporters
Awards
Programs
Programs Info
Lidz on Kidz
Brain Connect
>
Device Program
Tech Talks
Tech Guides
Testimonials
IPV Program
Young Brain Circle
Weekly Support Groups
Peer Support Program
Caregivers
Art Therapy Programs
>
Unmasking Brain Injury
Acrylic Paint Pouring
Fused Glass
Mugs
Gupta Exhibition
Events & News
Events & News Info
News
Upcoming Events
>
A Moment in Time
Past Events
>
Winter Sports Helmet Giveaway
BIAWW Picnic
BIAWW Walk, Run and Roll 2022
BIAWW Walk, Run and Roll 2021
Lidz on Kidz 2022
Lidz on Kidz 2021
Greeting Cards
Lidz on Kidz 2020
Oktoberfest Warm-Up 2019
Comedy Night 2019
Oktoberfest Warm-Up 2018
Comedy Night 2018
Resources
Resources Info
COVID-19 Update
OBIA Helpline
Education Programs
>
Grades 1-3
Grades 4-6
Grades 7-8
Brain Basics
Other Brain Injury Resources
Community
Community Info
Associations in Ontario
Professional Directory
>
Attendant Care Nursing Services
Case Management
Clinical Neuro-Psychologist
Occupational Therapist
Optometrist
Personal Injury Lawyers
>
Choosing a Lawyer
Physiotherapist
Rehabilitation Therapist
Speech Language Pathologist
Vestibular Rehabilitation
Community Partners
Get Involved
Get Involved Info
Membership
Donate
Send Greeting Cards
Corporate Giving
In Memoriams
Volunteer
Job opportunities
Contact Us
