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Physical Therapy Session

Self-Referral Form

Thank you for your interest in the Ontario Community Physiotherapy Clinic Program. Below is the Self-Referral form for you to complete. Please read the patient information sheet to ensure that this program is right for you ad 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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