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Forms

Accessing Services at the I CAN Centre

How do I start the referral process for the I CAN Centre?

  1. Download and print the referral form, Request for Service, Adult or Request for Service, Child.
  2. The Request for Service form is to be filled out by the patient or family, and/or a health professional or school staff.
  3. In addition, complete the secondary form(s) as indicated in the Request for Service forms. Send them in together to the address listed at the bottom of the Request for Service form to begin the referral process.
    Secondary Forms
  4. Once completed, forward to:

I CAN Centre for Assistive Technology
Room38, 10230-111 Avenue,
Edmonton, Alberta
T5G 0B7
Email: icancentre@albertahealthservices.ca
Phone: 780- 735-6070
Fax: 780-735-6072