151 Pine Valley Drive
London, Ontario N6J 4M2
519-435-6499
866-504-3115 (Fax)
Children 6 - 12 years old
ALL CHILDREN 10 AND UNDER WHO ARE REFERRED FOR AN AUTISM ASSESSMENT MUST BE SEEN IN-PERSON, AT MY OFFICE IN LONDON. THERE ARE NO EXCEPTIONS.
If you cannot travel to see me in-person, then ask your doctor or nurse practitioner to refer you to someone more local to you.
Click on the PDF icon to download the Parents’ Questionnaire to your computer. Once you have completed the questionnaire, click on the 'Submit' button to send it to me directly via your computer's default e-mail program. If you use a web-based e-mail (i.e. Gmail, Hotmail, Yahoo, etc.), you will need to go into your e-mail and send it to me (as an attachment) at drtemplemanintake@gmail.com. After you have submitted it, you will receive a confirmation email from my office that I have received it. If you do not receive this confirmation email, I have not received it yet. Please note that this email is NOT MONITORED by humans and is ONLY used to receive intake files. If you are sending any other supporting documentation, please be sure to put the child's first and last name in the subject heading of the email.