FOR REFERRING PHYSICIANS
Download and Submit a Referral
Download the clinic’s physician referral form, complete the required sections, and sign and date it. Fax the completed form to 416 620 7874 or contact us. We also accept your own referral form when the relevant information is included.
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
Fax Filled Form
- Save a completed copy for your records
- Fax the signed and dated form to our clinic
- Our team will contact the patient with appointment details
Need Help With the Form?
Call 416 626 2100 with questions about the form or contact our Clinical Director to discuss a referral.