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Home
About Us
Our Team
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Acquired Brain Injury
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Shop Online
Annual Reports
Sponsors and Supporters
Awards and Appreciation
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Survivor Programs
>
Art Programs
>
Greeting Cards
Unmasking Brain Injury
Acrylic Paint Pouring
Fused Glass
Ceramics
Gupta Exhibition
Brain Art
Brain Connect
>
Device Program
Tech Talks
Tech Guides
Tech Videos
Testimonials
Brain Makers
Support Groups
>
Drop-in Support Groups
Peer Support Program
Young Brain Circle
>
Stress Management
Pain Management Strategies
Social Relationships and Communication
Apps and Technology
Mindfulness and Meditation
Caregiver Programs
>
Caregivers
Community Programs
>
Lidz on Kidz
Seniors-Brain Link
IPV Program
Events & News
News
Upcoming Events
Past Events
>
2024
2022/2023
2020/2021
2018/2019
Pre-2019 Event Sponsors
Resources
Automotive Insurance
Brain Basics
Caregiver Program for Parents
Recovery
COVID-19 Update
Education Programs
>
Grades 1-3
Grades 4-6
Grades 7-8
Family Caregivers: Introduction to Brain Injury
OBIA Helpline
Other Brain Injury Resources
>
Coma Scales
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>
Attendant Care Nursing Services
Case Management
Clinical Neuro-Psychologist
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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
*
Submit
Home
About Us
Our Team
Newsletters
Acquired Brain Injury
Survivor Stories
Survivor Profiles
Shop Online
Annual Reports
Sponsors and Supporters
Awards and Appreciation
Programs
Survivor Programs
>
Art Programs
>
Greeting Cards
Unmasking Brain Injury
Acrylic Paint Pouring
Fused Glass
Ceramics
Gupta Exhibition
Brain Art
Brain Connect
>
Device Program
Tech Talks
Tech Guides
Tech Videos
Testimonials
Brain Makers
Support Groups
>
Drop-in Support Groups
Peer Support Program
Young Brain Circle
>
Stress Management
Pain Management Strategies
Social Relationships and Communication
Apps and Technology
Mindfulness and Meditation
Caregiver Programs
>
Caregivers
Community Programs
>
Lidz on Kidz
Seniors-Brain Link
IPV Program
Events & News
News
Upcoming Events
Past Events
>
2024
2022/2023
2020/2021
2018/2019
Pre-2019 Event Sponsors
Resources
Automotive Insurance
Brain Basics
Caregiver Program for Parents
Recovery
COVID-19 Update
Education Programs
>
Grades 1-3
Grades 4-6
Grades 7-8
Family Caregivers: Introduction to Brain Injury
OBIA Helpline
Other Brain Injury Resources
>
Coma Scales
Community
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
Membership
Send Greeting Cards
Legacy Giving
Donate
>
Flipgive
Corporate Giving
In Memoriams
Volunteer
Job opportunities
Contact Us
