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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 This is the link to the referral form and instructions for where to fax the completed referral form for ABI inpatient rehab. 
Version 2.1 Cluster 2 Acute to Rehab/CCC Provincial Referrals Standards (PRS) This is the standardized provincial form for referrals to inpatient rehab and CCC. It can be used alone or with the supplemental referral information form. (Not used for stroke patients.)
GTA Rehab Network Supplemental Referral Information Form This form is used with the standardized provincial form for programs that use a two-step referral process. i.e., when supplemental information is sent separately and closer to the time of admission. (Not used for stroke patients.)
GTA Rehab Network Integrated Acute Care to Inpatient Rehab/CCC Referral Form This form combines the standardized provincial form with the supplementary referral information form. It is used for programs that use a one-step referral process. i.e., when all information is sent when the referral is initiated. (Not used for stroke patients.)
Reference Guide for Inpatient Rehab/CCC Referrals This guide provides information on the use of the three referral forms above.
E-Stroke Inpatient Rehab Referral Form This form is used 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 This is the link to the referral form and instructions for outpatient and community-based referrals. 
Outpatient/Ambulatory Rehab Referral This form is used 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 This form is used 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  This form for outpatient total joint replacement rehab includes a listing of GTA Rehab Network member hospitals within the GTA that accept external referrals. 
TJR Outpatient Rehab Follow-Up Form  This form supports 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.