Make A Referral

Referrals are accepted from anyone – you, a family member, health care professionals, employer, and legal representatives.

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.

    Client Information

    Referred By

    Legal Representation

    Same as Referral

    Insurance Information

    No Insurance

    Same as Referral

    Reason for Referral

    Occupational Therapy

    Case Management

    Speech Language Pathology

    Life Care Plan

    Other

    Chronic Pain Management Program

    Mindfulness Program

    Post-Concussion Program

    Referral Requirements

    File Attachments

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