• Form

  • Thank you for your time.

    This intake takes approximately five minutes to complete.It is designed to collect high-level information to identify systemic patterns in publicly funded care and support services. It is not intended to document every detail of an individual experience. You may skip any question you are not comfortable answering.

  • Refined Introduction

    Refined IntroductionFamilies and legal decision-makers often hesitate to speak out because of fear of retaliation, loss of access, or further harm to their loved one. Advocates for Access & Accountability (AAA) understands these risks.This intake form provides a confidential, respectful and ethical way to document experiences related to publicly funded disability, developmental, long-term care, and community-based support programs. Information shared through this form is used to identify systemic patterns, inform policy analysis, support public-interest advocacy, and promote accountability and program improvement. AAA does not investigate individual cases, intervene directly with service providers, or provide legal or advocacy representation. Participation is voluntary and you may skip any question you are not comfortable answering.

  • Privacy, Confidentiality & Safety

    Privacy, Confidentiality & SafetyYour submission is treated as confidential.Identifying information, including names, locations, organizations, or other personal identifiers, will not be published or shared publicly without your explicit consent.Information collected through this intake may be aggregated, de-identified, analyzed, and summarized to identify trends, systemic risks, oversight gaps, and patterns across publicly funded programs. De-identified information may be used in reports, submissions, public education materials, and advocacy initiatives that serve the public interest.Advocates for Access & Accountability (AAA) does not contact service providers, government bodies, or third parties regarding individual submissions and does not verify, adjudicate, or resolve individual complaints.Participation in this intake does not create a client relationship, duty of care, legal obligation, or expectation of follow-up.If there is an immediate risk to health or safety, please contact emergency services, medical professionals, or legal counsel. Personal information, if voluntarily provided, is collected for consent, context and record integrity and is handled in accordance with applicable privacy and confidentiality principles.

  • Grounding Statement

    Grounding StatementThis intake focuses on system-level experiences rather than individual case resolution. You are not required to relive trauma or provide exhaustive detail. Clear and factual responses, even brief ones are sufficient and valued.

  • Section 1: About You

  • Your relationship to the person receiving care
  • Do you hold legal authority related to care or decision-making?
  • Do you manage or have signing authority over your loved one’s finances or bank account?

  • Section 2: Location & Care Setting

  • Type of care setting
  • Is this care setting regulated or licensed?

  • Section 3: Service Provider Information

  • Is this provider publicly funded or contracted by government?
  • Length of time your loved one has received services from this provider

  • Section 4: Access & Legal Authority

  • Have you experienced any of the following? (Select all that apply)
  • Has your loved one been denied family contact or visits?

  • Section 5: Harassment, Retaliation & Conduct

  • After raising concerns, have you experienced harassment, intimidation, or retaliation?
  • If yes or unsure, who was involved?
  • Do you fear retaliation or further loss of access if you speak publicly?

  • Section 6: Health, Safety, Communication & Duration

  • Has health and personal care information been shared with family or the legal authority in care?
  • Is there regular communication about your loved one’s care and well-being?
  • Does the care setting engage family and legal authority collaboratively in care planning and decisions?
  • Has a trespass or access restriction been issued or threatened?
  • If yes or threatened, how long did the restriction remain in effect?
  • How long have concerns related to health, care, safety, or well-being been occurring?

  • Section 7: Harm & Non-Disclosure

  • Are you aware of injuries, incidents, or harm that were not disclosed promptly or transparently?
  • Types of harm involved (if known and select all that apply)
  • If there were concerns of abuse, injuries were they addressed timely and to your satisfaction by care provider?

  • Section 8: Care Planning, Legal Authority & Assessment

  • Please indicate which have been provided (select all those that apply)
  • For any plans provided, was the legal authority involved in development and approval?

  • Care Assessments

  • When was the most recent formal care or needs assessment completed?
  • Has there been a decline in health care in the last 3 months? If yes, are additional health care and community supports needed?
  • Who conducted the assessment?
  • Was the family or legal authority in care included in the assessment?
  • Were assessment findings shared in writing with the legal authority?

  • Section 9: Government & Legal Processes

  • Are government programs aware of these concerns?
  • Have you filed or considered any of the following?
  • Do you have documentation related to your experience?

  • Section 11: Sharing Your Story

  • Would you be willing to share your story to support advocacy and awareness?

  • Intake Consent

    By submitting this form, I understand that the information I provide is shared voluntarily with Advocates for Access & Accountability (AAA). I consent to the confidential collection, use, aggregation, analysis, and de-identification of my information for purposes including pattern identification, policy analysis, public-interest advocacy, transparency and program improvement.

    I understand that AAA does not investigate individual cases, intervene with service providers, or provide legal representation, and that identifying information will not be shared publicly without my explicit consent.

  • How long did you wait for care and community support services?
  • For those families receiving care and supportive services and have experienced institutional abuse and systemic discrimination, the question is, if you knew what you know now, would you have placed your loved in a publicly funded group home, special care home?
  • Has the quality of life or health deteriorated since entering a publicly funded group home or special care home?
  • What age cohort is your loved one needing health care support services?
  • Your loved one is 21 years of age or older, are they currently receiving publicly funded health care or community supports, including programming, inclusion, or activities?
  • If supports are in place, approximately how many hours per week are provided?

  • The following questions apply only to Ontario. If this does not apply to you, please select “Not applicable.”

  • If applicable, how would you rate Disability Services Ontario (DSO) in the following areas? Areas to consider: response time; information sharing and clarity; service coordination or resolution; and collaboration with family or legal authority.
  • Based on your experience seeking care or service resolution, have you had direct communication with the Ontario government or the Ministry of Children, Community and Social Services?
  • If yes, were government representatives transparent and helpful in addressing care or service resolution concerns?

  • Closing Statement

    Thank you for contributing your experience. The information you share helps expose patterns that are too often dismissed when families are isolated and voices are treated as individual complaints rather than collective evidence.

    Those who depend on publicly funded care are loved deeply by their families, just as families place trust in governments, service providers, and communities to act with integrity, competence, and care. When that trust is broken, and when harm, exclusion, or neglect is ignored despite sustained effort, love alone is not enough to secure protection or reform.

    This intake exists to ensure that lived experiences are documented, respected, and counted. What has been ignored in isolation can no longer be dismissed in aggregate. The loss of voice ends here.

    Lost Voices. Real Stories. Real Families. No Longer in the Shadows.

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