Easy Referral

Ready to refer a patient? We make the referral process both easy and efficient for optometrists, physicians, dentists, and other healthcare providers.

How It Works

A Simple, Three-Step Process

[PLACEHOLDER: Adjust these steps to reflect your actual referral workflow.]

Submit the Referral

Complete the form below or send us your referral by fax or email — whichever is easiest for your practice.

We Review & Triage

Our clinical team reviews each referral promptly and prioritizes urgent cases accordingly.

We Contact the Patient

We reach out directly to schedule the appointment and keep your office informed along the way.

Direct Referral

Prefer Fax or Email?

You're welcome to send referrals directly using your standard referral form.

Fax[PLACEHOLDER Fax Number]
Email[PLACEHOLDER Referrals Email]
Phone[PLACEHOLDER Phone Number]

[PLACEHOLDER: Note any required intake documents — e.g. OHIP card copy, recent test results, imaging.]

[Referral form / fax cover sheet download placeholder]

Online Referral Form

Refer a Patient

Fields marked required must be completed. This form is a placeholder — connect it to a secure intake system or fax-to-email service before going live, since referrals may include personal health information.

Referring Provider

Provider Name

Clinic / Practice Name

Phone

Fax

Provider Email

Patient Information

Patient Name

Date of Birth

Patient Phone

Health Card Number

Referral Details

Referring For

Urgency

Reason for Referral / Relevant History

Attachments