Outpatient MD Clinic Referral Form 2026

1. Click ‘Get Form’ to open the Outpatient MD Clinic Referral Form in our editor.
2. Begin by entering the patient information. Fill in the fields for Name, Address, Date of Birth, Health Card number, and Daytime Contact Number.
3. Next, specify the Family Doctor's name and Version Code. For emergency contacts, provide the name, phone number, and relationship of the person to arrange appointments.
4. Select the service being referred for by checking the appropriate box next to options like Endocrinology or General Internal Medicine.
5. In the 'Reason for Referral' section, provide a brief description of why the referral is necessary.
6. Attach any required documents such as medical history and lab data by using our platform’s upload feature.
7. Complete the Referring Physician information with your details including Name, Billing Number, Address, Telephone, and Signature.
8. Finally, fax the completed referral form to 416-461-2089 as instructed.

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