Patient Referral Form

This form is required for all medical (OHIP Billable) services. Referrals are not required for our Chiropractic/Massage/Naturopathy/Psychology/Mindfulness services.

To refer patients to our clinic please click the download link to fill in the PDF and return it to us along with any additional relevant documents pertaining to the patient's history.

To attach additional documents, please email the relevant pages to referrals@painandwellnesscentre.com or fax the form to our toll free fax number: 1 (844) 358-9308. You must include the "1" for the fax to be delivered. Please be sure to include your patient's name in the subject line.

If you have any questions please give us a call at 1 (800) 597-5733

Please note that we only accept referrals for patients living north of Highway 401.

Download The PDF Version Of Our Referral Form