Please fill in and submit this form and we will call you to confirm and book an appointment. This form is also used for registration in our Group programs – see Groups under Reason for Referral.

A doctor’s note or prescription is not required by us, but may be required by your extended health insurance.
Please note that our services are not covered by OHIP.

Please feel free to fill in the form below, or give us a call directly at 1-800-554-8118.
You are also welcome to send an email to referrals@modernOT.ca.