Referral Form

We Are Accepting Referrals

Thank you for your consideration. 

We look forward to working with you.

To refer a client to us, simply call us or complete the referral form on this page.

Toronto: (416) 254 -0252

Markham: (905) 294-3551

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Referring Doctor (required)

Referring Doctor Email (required)

Referring Doctor Telephone (required)

Name Of Referred Client (required)

Telephone Of Referred Client (required)

Reason For Referral And Notes