Outpatient/Ambulatory

These forms are periodically modified. To make sure you are using the most current version of the form you require, please download it from this webpage.

The form is for all referrals to day hospital programs and/or outpatient rehab services where more than one rehab service is required, except:

• Outpatient stroke rehab referrals made by acute care hospitals in Toronto who use the E-Stroke Rehab Referral system (continue to use the electronic referral system)

Other

Referral forms for other types of service may be accessed through the links below:

• Central LHIN Diabetes Education Program Physician Referral Form
• Toronto Central Diabetes Education Program Referral Form for Type 2 Diabetes and Prediabetes
• Toronto Rehab's Dialysis Service