Physician Referral

Physician Referral Form (Option1)

Please have a physician complete the physician referral form below
and fax to (647) 480-0909

Once the referral is received, our staff will review it and will respond
to the referral request.

Physician Referral

    Online Referral (Option2)

    Patient Information

    Department & urgency

    Referral To: (select all that apply)

    Referral Urgency

    0 of 1000 max characters

    Please fax additional documents to 647.480.0909


    REMINDER - Please include child's name on your faxes.

    Please confirm all information above is correct *


    * Required field