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Families Matter Calgary
Home > Intake Referral Form

Intake Referral Form

  • Parent/Guardian Information

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Child Information

  • MM slash DD slash YYYY
  • Language primarily spoken at home

  • SIBLINGS

  • First name, Last name, Date of Birth, Gender, lives with Child
  • Describe specific, emotional, behavioural and mental health concerns.
  • Are you or have you ever been involved with community agencies, groups or programs (including Child and Family Services)?
  • Name of Service, Purpose of Involvement, Date
  • Additional comments or concerns that would help to understand your situation.
  • to discuss or release information to Families Matter Individualized Support program for the purposes of referral and assessment.

Families Matter

info@familiesmatter.ca

intake@familiesmatter.ca

Horizon / Admin Centre

#3404 25th Street N.E.

T1Y 6C1

P: 403.205.5178

F: 587.393.5148

Intake: 403.205.5194

Triwood Family Centre

4004 19th Street N.W.

T2L 2B6

P: 403.205.5178

Midnapore Family Centre

#101 239 Midpark Way SE

T2X 1M2

P: 403.288.1446

F: 587.393.5148

Intake: 403.205.5180

© 2023 Families Matter Calgary.

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Close Menu
Volunteer with Us!
  • About Us
    • What’s New
    • Financial & Annual Reports
    • Careers
    • Frequently Asked Questions
    • Volunteer
    • Donate
  • Our Programs & Services
    • Dialectical Behaviour Therapy (DBT) Skills Groups
    • Early Learning Across Cultures – Kindergarten Readiness
    • Family Resilience Home Visitation
    • Fathering for the Future
    • Keys to ResilienceFamily Centre Programming
      • Fall & Winter Drop-In Programming*NEW DATES ADDED*
    • Perinatal Mental Health
      (Postpartum Depression)
      • Perinatal Mental Health Support Groups
      • PMH Peer Support for Black Women
    • Successful Young Parents
    • Youth Programs
    • Professional Development
  • Register for Classes
    • Dads Programs
    • Parent Classes
    • Parent & Child Together Classes
    • Ages & Stages Questionnaire (ASQ) Screenings*NEW*
    • Front Runners/Youth Programs
  • Contact Us
    • Our Centres
  • Family Resource Network
  • Donate Now
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  • facebook
  • instagram