MD Referral Form MD Referral Web Form COVID-19 Update
MD Referral Web Form MD Referral Form COVID-19 Update

Referral Form Request

Patient Referral Form

Date:

Referring Provider & Patient Information

Referral For
  
Electronic Signature:
Please enter your Electronic Signature.

Physiomed is a franchised network of over 30 healfthcare clinics featuring an interdisciplinary team that includes Physicians, Physiotherapists, Chiropractors, Chiropodists, Naturopaths and Registered Massage Therapists that has helped improve the health and fitness of over one hundred thousand Canadians.

Our Content

Want to learn more about the various factors affecting your health, including tips for making specific improvements? Check out the following samples from our blog or visits our archives for information on topics of particular relevance to you:

seniors-aging-waist-down
15Apr

Aging From The Waist Down – Why...

Posted by

As we age, staying healthy and active is one of the most important things that we can do for... READ MORE

01Apr

Joint and Bone Essentials – 4 Things...

Posted by

Arthritis is an extremely painful condition that affects over six million Canadians. READ MORE

Getting Back In the Game After an ACL Tear
15Mar

Getting Back In the Game After an ACL...

Posted by

An Anterior Cruciate Ligament (ACL) tear used to be a career-ending injury. READ MORE

Bounding Back from Weight Gained During the Pandemic
01Mar

Bounding Back from Weight Gained During...

Posted by

If you’ve gained weight during the pandemic, you’re not alone. READ MORE