Clinic referral forms.

Open the form for your receiving clinic and send the completed referral to its fax number below.

Choose the receiving clinic.

02

Peel region

Mississauga

3580 Thomas St., Unit 103, Mississauga, ON L5M 0G2
Referral fax
866-907-3584
03

East Toronto

Scarborough

520 Ellesmere Rd Unit 404, Scarborough, ON M1R 0B1
Referral fax
877-796-4626
04

Niagara region

Niagara Falls

8375 Lundy's Lane, Unit 100, Niagara Falls, ON L2H 1H5
Referral fax
855-274-7729
05

North Toronto

York Diagnostic Centre

3585 Keele Street, Unit 4, Toronto, ON, M3J 3H5
Referral fax
416-398-2588
06

Waterloo region

Kitchener

148 Manitou Drive, Suite 102, Kitchener, ON N2C 1L3
Referral fax
833-467-0866

Send a referral in three steps.

  1. 01
    Open

    Choose the receiving clinic’s PDF above.

  2. 02
    Complete

    Fill in the requested information and include the supporting documents specified on the form.

  3. 03
    Fax

    Send to that clinic’s referral fax and retain your transmission confirmation.

Here to help

Need to confirm a referral?