• Home
  • Contact Us
  • Site Map
Text Size A+ A-

Referral Forms

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

NOTE: For all referrals (excluding referrals to ABI rehab), please fax referral forms directly to the programs being requested. Program details and contact information can be found through Rehab Finder

Referrals to Inpatient Rehab/CCC
Acquired Brain Injury Rehab Referral Use this link to access the referral form and instructions for where to fax the completed referral form for ABI inpatient rehab. 
GTA Rehab Network Integrated Acute Care to Bedded Levels of Rehabilitative Care & CCC Referral Form

Use this form for referrals to inpatient (bedded) rehab/CCC programs provided by member organizations of the GTA Rehab Network. (Note: Not used for stroke patients.)

This form is a customized version of the Provincial Referral Standards referral form for the GTA.

GTA Rehab Network Supplemental Referral Information Form This form is an abridged version of the form above. Use this form to provide updates on patients that have already been referred. (Note: Not used for stroke patients.) 
Reference Guide for Inpatient Rehab/CCC Referrals (Sept 2018) This guide provides information on the referral forms above.
Rehabilitative Care Alliance: Definitions Framework for Bedded Levels of Rehabilitative Care (updated July 2017)

Framework defines four bedded levels of rehabilitative care (rehabilitation, activation/restoration, short term and long-term complex medical management). Definitions for each level describe:

  • patient characteristics (target population, functional characteristics, estimated average LOS and discharge indicators);
  • medical/allied health resources (medical, nursing and therapy care; intensity of therapy); and
  • reporting tools.
Key features of RCA Bedded Levels of Rehabilitative Care

Key features of each of the bedded levels of rehabilitative care.

E-Stroke Inpatient Rehab Referral Form Use this form for stroke referrals for organizations that do not have access to the E-Stroke Rehab Referral System.
Referrals to Outpatient/Ambulatory Rehab
Acquired Brain Injury Outpatient Rehab Referral Form Use this link to access the referral form and instructions for outpatient and community-based referrals. 
Outpatient/Ambulatory Rehab Referral Use this form for all rehab populations except total joint replacements and acquired brain injury. (See separate sections for instructions on these populations.) The form may be completed online, printed and faxed OR printed, completed by hand and faxed. 
E-Stroke Outpatient Rehab Referral Form Use this form for stroke referrals from acute care organizations that do not have access to the E-Stroke Rehab Referral System. 
Total Joint Replacement
TJR Outpatient Rehab Referral Form  Use this form for outpatient total joint replacement rehab referrals provided by member organizations of the GTA Rehab Network. It includes a listing of GTA Rehab Network member hospitals within the GTA that accept external referrals.  
TJR Outpatient Rehab Follow-Up Form  Use this form to support the communication between the outpatient rehabilitation physiotherapist and the client's orthopaedic surgeon. 
Listing of TJR Outpatient Rehab Programs that Accept External Referrals This comprehensive listing identifies outpatient rehab programs across the GTA that will accept external referrals for outpatient rehab following TJR.