GRRCC New patient Referral Form - Grand River Hospital 2026

1. Click ‘Get Form’ to open the GRRCC New patient Referral Form in the editor.
2. Begin by filling out the PATIENT’S PERSONAL INFORMATION section. Enter the patient's name, address, postal code, date of birth, and contact numbers. Ensure all fields are completed accurately.
3. In the REFERRAL INFORMATION section, the referring physician must provide their details including name, telephone number, and fax number. A mandatory signature is required here.
4. Indicate the reason for referral and check any applicable RCN criteria. If a previous colonoscopy was performed, specify if available operative/pathology reports can be provided.
5. Complete the PATIENT MEDICAL HISTORY section by listing current medications and allergies. Note any special considerations that may be necessary for patient care.
6. Finally, review all entered information for accuracy before submitting your form via fax to ensure a smooth referral process.

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