To access rehabilitation services in intellectual disability, autism spectrum disorder, or physical disability (ID-ASD-PD), a request must be made to the 
ID-ASD-PD Access Desk. The request will be processed in accordance with the criteria established by the Access Plan of the Ministry of Health and Social Services and depending on the required services. For any question in line with a request to the ID-ASD-PD Access Desk, we invite you to communicate with us:
Integrated Health and Social Services Network for West-Central Montreal
3500 Décarie Boulevard, Montreal, Quebec H4A 3J5
Email: 
guichet.ditsadp.ccomtl@ssss.gouv.qc.ca
Tel: 514-488-5552 ext. 1250
Fax: 514-488-8132
Miriam Home and Services
Intellectual disability and autism spectrum disorder rehabilitation services (ID-ASD)
Services can be accessed by referral from the CLSC.
A healthcare professional can make a service request using the following registration forms
OTHER REQUIRED DOCUMENTS:
- Complete evaluation report that confirms the ID-ASD diagnostic (IQ evaluation and adaptive behavioural) or global developmental delay
- Other professional reports (occupational therapist, physiotherapist, speech language pathologist, neuropsychologist, etc.) or pertinent medical files
Residential Integration:
- Multi-clientele evaluation tool (Outil d’évaluation multiclientèle - OEMC), or Functional autonomy measurement system (système de mesure de l'autonomie fonctionnelle - SMAF), or other pertinent evaluation of profile description
Constance-Lethbridge site
Physical disability rehabilitation (PD)
Recommendation from a physician is required.
For all programs please use the following registration form except the Driving Evaluation and Vehicle Adaptation Program and the Assistive Technology Program: see specific registration forms below
Other required documents
- Medical Report
- Reports from professionals documenting the severity and persistence of difficulties and impact on life habits
Traumatology
- Ambulance reports
- In addition, for BOGs: Operating protocol and examination report
- In addition, for TBI: Tracking Form, EEG and MRI
Driving Evaluation and Vehicle Adaptation Program
Other required documents
- In the case of a driver, include the medical form completed by a physician (M28 or M14) and a visual report completed by an optometrist or ophthalmologist (M5)
-
M5 - Vision examination report by an ophthalmologist or an optometrist - Driver's licence
- M28 - Medical examination report by a general practitioner- Driver's licence - In the case of a passenger, include a medical certificate
Assistive Technology Program
Other required documents
- Medical Report
- Health Professional reports documenting severity and persistence of difficulties, and impact on life habits
Chronic pain management
Request for consultation - Chronic pain management.pdf
This form must be completed by a doctor.
MAB-Mackay Site
PHYSICAL DISABILITY REHABILITATION (PD)
PLEASE USE THE FOLLOWING REGISTRATION FORM
OTHER REQUIRED DOCUMENTS
- Medical Report (when available)
- Health professional reports documenting severity and persistence of difficulties, and impact on life habits
- Clients with developmental coordination disorder: Additional information regarding the request for services
LANGUAGE DISABILITY
- Evaluation report in speech-language pathology (SPL) done in the past 12 months with the follow-up report(s)
- Other pertinent health professional report(s) facilitating the understanding of needs and lifestyle impacts
HEARING DISABILITY
- Audiology assessment report
- For disturbing tinnitus and Menière's disease: Ear, nose and throat (ENT)
- For auditory processing disorder: Evaluation report in speech language pathology and psychology
VISUAL DISABILITY
- Recent eye examination report REFERRAL FORM - Eye condition information
- Other pertinent health professional report (occupational or physiotherapy, psychology, optometry, etc.)
SALIVA MANAGEMENT CLINIC
SALIVA MANAGEMENT CLINIC PARENTS QUESTIONNAIRE