Referral Forms


Medical Referral

For a referral, please locate the clinic you wish to refer to, print and fill out the form. Once complete please fax it to the clinic. The fax number is at the top of the form.


PCC Mississauga Clinic

6981 Millcreek Drive - Unit 2
Mississauga, Ontario
L5N 6B8

Hamilton Clinic

701 Main Street West - Unit 100
Hamilton, Ontario
L8S 1A2

Oakville Clinic

245 Wyecroft Road - Unit 1
Oakville, Ontario
L6K 3Y6

Orangeville Clinic

33A Broadway Avenue - Unit 1
Orangeville, Ontario
L9W 1J7