FOR REFERRING PHYSICIANS
Download and Submit a Referral
Download our physician referral form or use your own form with the relevant patient and clinical information. Follow the checklist below before submitting your referral.
COMPLETE THE FORM
Before You Send
- Check the patient’s identity and contact details
- Select the reason for referral and procedure
- Include medical history, medications and allergies
- Complete the referring physician details and signature
SUBMIT YOUR REFERRAL
Send Your Referral
- Save a completed copy for your records
- Fax the signed and dated form to 416 620 7874
- Our team will contact the patient with appointment details
Need Help With the Form?
Have questions about the form or a referral? Contact our clinic team for assistance.