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TeleCheck Application

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TeleCheck is our outbound call program offering telephone support and friendly social connections to individuals experiencing isolation, and emotional and mental health concerns. TeleCheck clients receive regularly scheduled check-in calls from our trained volunteers, Monday to Friday from 9am to 5pm. All calls are free and completely confidential.

Anyone over 18 years of age can apply to enroll by completing the form below. Caregivers and health care professionals can use this form to refer eligible individuals under their care.

TeleCheck clients are welcome to call the Distress Line at any time in addition to receiving their scheduled calls. The Distress Line is available 24/7.

For more information regarding our TeleCheck program, please email telecheck@dchalton.ca or call 905-849-4559 x104.

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TeleCheck Application

Client Information:

Birthday:
Year
Month
Day

TeleCheck Call Information:

Reason for Referral
Have you recently been discharged from an emergency department?
Yes
No
Have you recently been discharged from a hospital inpatient unit?
Yes
No
Do you currently live alone?
Yes
No
Is it okay to leave a voicemail?
Yes
No
Is it okay to leave a message with someone other than the client?
Yes
No
I'd like to receive phone calls from TeleCheck on the following days:
I'd like to receive a phone call between 9am to 5pm:
Yes
No
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