Referral forms

Please complete the referral form for the service that you would like to refer your client to and fax it back to 416-690-5182. Please note that the referral form must be completed by your family doctor. The doctor will then receive a confirmation that the referral has been received and if it has been accepted. Please note that for the dietitian referrals we do require their latest most comprehensive blood work to be sent with the referral form.

SAFHT uses OCEANMD to send out intake forms. These forms are sent out when a referral is received and need to be completed prior to an appointment being scheduled. Please let your patient know that they will be receiving these forms and insure that their email address is correct. If your patient does not have an email address please note that on the referral and we will contact them to complete the form by phone.

The smoking censsation has a self-referral form and and one that can be completed by a family doctor. Please be sure to complete the appropriate one.

Mental Health Referral Form

Dietitian Referral Form

Chiropody Referral Form

Palliative Common Referral Form

Smoking Cessation Self-Referral Form

Smoking Cessation Family Doctor Referral Form