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 (Sept 2018)||
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. For details on completing form, see Reference Guide for Inpatient Rehab/CCC Referrals.
|GTA Rehab Network Supplemental Referral Information Form (Sept 2018)||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.) For details on completing form, see Reference Guide for Inpatient Rehab/CCC Referrals.|
|E-Stroke Inpatient Rehab Referral Form (Rev. Nov 2015)||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 (PDF) (Rev. June 2019)
Outpatient/Ambulatory Rehab Referral (Fillable) (Rev. June 2019)
|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 (Rev. Nov 2015)||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 (April 2019)||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 (June 2014)||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 (April 2019)||This comprehensive listing identifies outpatient rehab programs across the GTA that will accept external referrals for outpatient rehab following TJR.|