Poor handwriting is a common reason for referral to school-based occupational therapy. A survey was used to explore the extent to which current practice patterns in Ontario, Canada, align with evidence on effective intervention for handwriting. Knowledge-to-practice gaps were identified related to focus on performance components versus occupational performance. Therapists identified three learning needs: integrating technology, promoting handwriting practice, and addressing complex areas of difficulty in learning, attention, and language. Therapist and system barriers to best practice were identified. Support for challenging system barriers and access to relevant continuing education opportunities is indicated.