Foot and ankle clinic queensway carleton hospital 2025

1. Click ‘Get Form’ to open the foot and ankle screening and triage clinic referral form in the editor.
2. Begin by entering the patient's name and birth date in the designated fields. Ensure accuracy for proper identification.
3. Fill in the address, postal code, home phone number, OHIP number, and any alternate contact numbers. If applicable, indicate if the referral is from a specific hospital.
4. Select the reason for referral by checking the appropriate box for conditions such as bunion or Morton’s neuroma. Note that this clinic currently focuses on forefoot conditions only.
5. Complete the referring physician's details including name, billing number, address, phone number, and fax number. Don’t forget to sign and date the form.
6. If available, attach any relevant patient information such as consult letters or imaging reports by uploading them directly through our platform.

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