Get Appendix A Confirmation Of Diagnosis Form

Filling out the APPENDIX A Confirmation Of Diagnosis Form online is an important step in securing necessary services for a child diagnosed with Autism Spectrum Disorder. This comprehensive guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently.

Follow the steps to fill out the APPENDIX A Confirmation Of Diagnosis Form.

1. Click ‘Get Form’ button to access the document and open it in your preferred editor.
2. In the 'Child’s Information' section, enter the child's full name and gender, along with the name of their family physician. Fill in the child's birth date in the specified format (mm/dd/yyyy) and check the appropriate diagnosis box for Autism Spectrum Disorder. Additionally, select the preferred language of service by checking either French or English.
3. In the 'Diagnosing Professional’s Information' section, indicate the profession of the diagnosing professional, such as Physician, Psychologist, or another relevant title. Provide their full name, specialty, address including suite or building number, city, province, and telephone number. Don’t forget to include the professional’s signature and the date of completion.
4. Move to the 'Application for Services' section. Input the names of both parents or guardians, along with their respective mailing addresses, contact numbers, provinces, and email addresses. Ensure that both guardians provide their signatures in the designated space, indicating consent for the information submitted.
5. Once all sections are filled out completely and accurately, review the form for any errors or omissions. Make sure all required fields are completed.
6. Finally, save the changes made to the form. You can then download the document for your records, print it for submission, or share it via email as needed. Ensure that the completed form is mailed to the address provided in the instructions.

Start filling out the APPENDIX A Confirmation Of Diagnosis Form online today to ensure your child receives the necessary support.