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Physician Referral Form

Dear Physician,

We appreciate your trust. We will update you on your patients’ treatment program and their progress.

  • Download referral forms in PDF, complete and submit by email (please go to the bottom of this page)
  • Complete the Physician Referral Form below and click the ‘Send’ button to submit
  • Contact our clinics directly at 416-444-4800 

Once you submit a request through our web site or by fax, your patient will be contacted to schedule an appointment.

We value your trust to our care and gladly waive the $75.00 assessment fee for your patients who are referred to our two very popular programs:

GLA:D for Hip & Knee Osteoarthritis

Dizziness & Balance Exercise Program/VRT

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PHYSICIAN INFORMATION
Physician NamePhysician name
Physician Phone Numberyour full name
PATIENT INFORMATION
Patient First Nameyour full name
Patient Last Nameyour full name
Contact Phone Numberyour full name
DIAGNOSIS
Please provide Diagnosis heremore details
0 /
OTHER INFORMATION
Other Information (Optional)more details
0 /
Date of your Next Appointment with this Patientof appointment
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Physician Referral Forms (PDF)

Please download one or more of the following referral forms to complete and submit by email to: donmills@physiomobility.ca. 

General Patient Referral Pad
Pelvic Health Physiotherapy Referral
GLAD Program Referral
Vestibular Physiotherapy Referral Pad 

 

 

 

 

 

Province-wide Emergency Break – 2021

AS ESSENTIAL HEALTHCARE PROVIDERS, WE REMAIN OPEN FOR IN-CLINIC TREATMENTS DURING THE PROVINCE WIDE EMERGENCY BREAK ANNOUNCED ON APRIL 01, 2021 Physiomobility is open

Book your Appointment

Virtual appointments are available and encouraged for those who are at a heightened risk of illness.

Learn about Virtual Appointments

The Physiomobility Team

Read our COVID-19 Health & Safety Standards and Procedures

physiomobility_healthgroup-logo-2021

WE ARE OPEN

AS ESSENTIAL HEALTHCARE PROVIDERS, WE REMAIN OPEN FOR IN-CLINIC TREATMENTS DURING THE PROVINCE WIDE EMERGENCY BREAK ANNOUNCED ON APRIL 01, 2021

Physiomobility continues to remain open and is not part of the lockdown. We continue to have rigorous disinfection policies and procedures in place to ensure the safety of our community and are open for patient in-person visits with all of our practitioners.

Virtual appointments are available and encouraged for those who are at a heightened risk of illness.

We remain focused on our quality of care & our continued commitment to helping our patients feel their best. For further assistance, you can contact us at 416-444-4800 during our opening hours. 

The Physiomobility Team