Our physiotherapists accept referrals from other health care practitioners in Orleans, Ottawa and the surrounding areas.

Professional Referrals

If you have a patient who you think could benefit from physiotherapy or any of our other services, please fill out the form below, and we'll be in touch!

Patient Contact Details

First Name:

Last Name:

If the patient is a minor, please enter the name of the parent or guardian below:

Parent/Guardian First Name:

Parent/Guardian Last Name:

Contact Phone Number:

Email Address:

Health Care Provider Contact Details

Full Name:

Phone Number:

Email Address:

Referral Details:

Reason for Referral:

Type of Appointment Recommended:

Comments for the therapist:

Would you like to receive an assessment report?

Yes

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Professional Referrals