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Referral Forms
Thank you for your interest in the Ontario Community Physiotherapy Clinic Program. Below is the Self-Referral form for you to complete. There is also a Physician Referral Form that can be filled out by your physician. Please read the patient information sheet to ensure that this program is right for you and that you meet eligibility criteria.
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We recommend that you hand deliver this form to the location of your choice as this form contains personal health information and should not be sent via email.
Trusted and recommend by physicians in Halton.
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