Form online 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting the clinic your patient is being referred to by checking either 'Rapid Access Clinic' or 'Booked Appointment'.
3. Fill in the Referring Provider section with your OHIP Billing number, office phone, fax, and address.
4. Enter the patient's details including their name, health card number, date of birth (in D-M-Y format), address, and phone number.
5. In the Reason for Referral section, check all applicable conditions such as 'Moderate to Severe Psoriasis', 'Acne / Rosacea', or others listed.
6. Review all entered information for accuracy before submitting the form.

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