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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as confidential.Identifying information, including names, locations, organizations, or other personal identifiers, will not be published or shared publicly without your explicit consent.Information collected through this intake may be aggregated, de-identified, analyzed, and summarized to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
ParentSiblingLegal Guardian/Substitute Decision MakerOther Family Member
Appointed GuardianSubstitute Decision Maker (health or finances)Power of Attorney (health or finances)Shared AuthorityNo Formal AuthorityUnsure
YesNoShared responsibilityNot Applicable or Unsure
Section 2: Location & Care Setting
Province or territory where care is provided
Group homeLong Term CareSpecial Care HomeSupported or Assisted LivingDay or Community Program (living at home with family)
YesNoUnsure
Section 3: Service Provider Information
YesNoUnsure
Less than 1 year1–2 years2-3 years3 to 5 yearsOver 5 years
If you are comfortable, please identify the service provider associated with the concerns described, including city (optional). This information is used for internal pattern tracking only and is not published without explicit consent.
Section 4: Access & Legal Authority
Denied or restricted access to your loved oneTrespass notice or threat of trespassExclusion from care planningExclusion from health or medical decisionsDisregard for legal authorityDenial of day programming or community supportsRestricted communication channelsOther
YesNoPartially or inconsistentlyUnsure
Please describe what occurred.
Section 5: Harassment, Retaliation & Conduct
YesNoUnsure
Front-line staffManagement or supervisorsExecutive leadershipGovernmentMultiple levelsExternal - legal counselNot applicable in response
YesNoUnsure
Section 6: Health, Safety, Communication & Duration
Yes — consistently and proactivelyYes — only when requestedInconsistentlyNoUnsure
WeeklyMonthlyIrregular or as issues ariseNo regular communicationNeverUnsure
Yes — as collaborative partnersLimited engagementEngagement only after escalationNo engagementUnsure
YesThreatenedNoUnsure
Less than 1 month1 to 3 months3 to 6 monthsMore than 6 monthsOngoingNot applicable in response
Less than 1 year1–2 years2–3 yearsMore than 3 yearsUnsure
Section 7: Harm & Non-Disclosure
YesNoUnsure
Physical injuryMedical neglectPsychological or emotional harmSexual harmFinancial exploitationUse of restraint or coercive controlNeglect of basic careOther or unclear
YesYes - abuse policy applied and complaint process followedNoNo - abuse policy was not applied and complaint process ignoredOngoingUnsureNot applicable in response
Section 8: Care Planning, Legal Authority & Assessment
Service agreementIndividual Support PlanBehavioural Plan/Safety PlanCare AsssessmentHome keyMeal Plans (monthly)Community activity schedules (monthly)Receipts for expensesHealth care summaries: (doctor, dentist, personal services)Health care weekly updates
Yes — fully involved and approval respectedInvolved, but concerns were dismissedNot involved or excludedPlans implemented without consentUnsure or not applicable
Care Assessments
Within the last 6 months6–12 months ago1–2 years agoMore than 2 years agoUnsureNo assessment completed
YesNoUnsureNo applicable
Service provider contracted to delivery public programsGovernment ministryGovernment regulatory agencyExternal assessor or clinicianUnsure
Yes — actively involvedConsulted, but input not reflectedInformed after completionExcluded entirelyUnsure
Yes — promptly and in fullPartiallyDelayedNot sharedUnsure
Section 9: Government & Legal Processes
Ontario Ministry of Children, Community and Social ServicesOntario Ministry of Health or long-term care oversightOther provincial or territorial programNoUnsureOther regulatory agencies contacted for help
Residential Tenancies Act applicationOntario Human Rights Code or Human Rights TribunalOmbudsman complaintInformation PrivacyPolicePrefer not to sayNo
Emails or correspondenceIncident or injury reportsCare plans or service agreementsMedical or assessment recordsLegal filingsFinancial or funding recordsNone available
Section 11: Sharing Your Story
Yes — anonymouslyYes — publicly, with my nameYes — for blogs or written storiesYes — for podcasts or audioYes — for media inquiriesNot at this time
Lost Voice. Real Stories. Real Families. No longer in the Shadows. What are your thoughts on the experience you and your family have encountered. It is, the beginning of a collective voice. We see. We document. We act.
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.
I confirm that I have read and consent.
What is your full name?
What is the name of your loved one?
What is your telephone number?
What is your email address?
What is today's date, including month, date and year.
Less than 2 years2 to 5 years5 to 10 years11 to 15 years16 to 20 yearsover 20 years
YesNoNot applicable
YesNoNot applicable
Under 10 years of age10 to 15 years16 to 20 years21 to 25 years26 to 30 years31 to 35 years35 to 40 years41 to 45 years46 to 50 yearsOver 50 years
YesLimited or inconsistent supportsNo meaningful supportsUnsureNot applicable (under 21)
Less than 5 hours5–10 hours11–20 hoursMore than 20 hoursUnsureNot applicable
The following questions apply only to Ontario. If this does not apply to you, please select “Not applicable.”
No valuePoorAdequateSatisfactoryStrongNot applicate
YesNoUnsureNot applicable
YesNoPartiallyUnsureNot applicable
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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Form

Thank you for your time.

Refined Introduction

Privacy, Confidentiality & Safety

Grounding Statement