Toll Free @ 1-800-525-9281 Mississauga 905-279-9971 Georgetown 905-877-0147               
Open Hours Mississauga: Mon-Th 8:30-4:30, Fri 8:30-1:00                Georgetown: Tue-Th 8:30-4:30, Fri 8:30-1:00

Referral Form

If you have a patient referral, please download, fill in and fax this referral form to the appropriate office as per the fax numbers on the form, or fill out our online form.

Thank you for referring us to your patients.

DOWNLOAD REFERRAL FORM (PDF)

Download Referral Form  Referral Form (PDF / 110KB)

This form is in .PDF file format. To view .PDF file you require Adobe Acrobat Reader installed on your computer.

Online Form

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