Physio referral form 2026

1. Click ‘Get Form’ to open the physio referral form in the editor.
2. Begin by entering the patient information. Fill in the name, birth date, address, home telephone number, and family contact if applicable.
3. In the diagnosis/reason for referral section, provide a brief description of the patient's condition or reason for seeking physiotherapy.
4. If available, input any XRay/CT/MRI results that are relevant to the referral.
5. List any relevant medications and medical history that may assist the physiotherapist in understanding the patient's background.
6. Check all applicable reasons for referral from the provided options such as post-op follow-up or falls prevention.
7. Complete the referral source section by printing your name, signing, and providing your phone and fax numbers along with the date.
8. Once completed, save your changes and follow instructions to fax the referral to 1-250-594-6603.

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