PHYSICAN REFERRAL FORM FOR PHYSIOTHERAPY
Thank you for your referral, and we appreciate your trust. We will update you on your patients’ treatment program and their progress.
There are three ways to refer your patient:
- Complete the Physician Referral Form below and please click the SUBMIT button to send to our clinic.
- Download the referral form, complete and submit by email to firstname.lastname@example.org or fax to 519-433-6186.
- Contact our clinic directly by calling us at 519-433-6713
Once you submit a request through our website, fax or email, your patient will be contacted to schedule an appointment. We do not have a waiting list currently.