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Refer a Patient

Refer a Patient

Refer a Patient Form

We have two options!

To PRINT our Refer a Patient Form, please click the button below. You are then able to print the form online, fill it out and bring it to our office before your appointment.  If the form is not filled out prior to your appointment, please arrive at our office 15 minutes prior to your scheduled time. 

To FILL OUT and EMAIL the Refer a Patient Form directly to our office, just simply click button below. No extra work necessary before your appointment.
Please do not use Safari as your internet browser. Chrome is the recommend browser to use for filling out the form.

Contact our office so we can help you schedule your appointment.


1 (800) 361-7203

Fax: 905-849-8428

Available from 7:30 AM – 5:00 PM

1525 Cornwall Road, Unit 21
Oakville, ON L6J 0B2

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