Forms

Admission/Referral Forms and Applications

For Your Convenience

If you do not have access to the Resource Matching and Referral (RM&R) electronic information and referral system, we have made available for download a selection Referral Forms as PDF files. These forms must be printed, completed and signed by a referring physician and faxed back to our Admitting Department at 416-243-8947.

Note: Consult and therapy notes must accompany all referral forms. Additional information may be required prior to admission to the Centre.

If you require any assistance in filling out a particular form or need further information regarding admission to West Park, please call 416-243-3626.

General Rehab CCC Inpatient Referral Form
Referral Forms
For admission information, please call the Admitting Department at West Park Healthcare Centre at 416-243-3632, or email admitting@westpark.org View
Pulmonary Function Exercise Test
Respiratory | Referral Forms
For more information, please call the Sleep Laboratory at 416-243-3631 or sleeplab@westpark.org. View
Respiratory - CAVC Inpatient Pre-Assessment Referral Form
Respiratory | Referral Forms
For admission information, please call the Admitting Department at West Park Healthcare Centre at 416-243-3632, or email admitting@westpark.org View
Respiratory - Respiratory Rehabilitation
Respiratory | Referral Forms
For admission information, please call the Admitting Department at West Park Healthcare Centre at 416-243-3632, or email admitting@westpark.org View
Respiratory - Transitional Home Ventilation Inpatient Pre-Assessment Referral Form
Respiratory | Referral Forms
For admission information, please call the Admitting Department at West Park Healthcare Centre at 416-243-3632, or email admitting@westpark.org View
Seniors Mental Health Service Referral Form
Seniors' Services | Referral Forms
Please download this form and contact the Seniors Mental Health Service at 416-243-3732. View
Sleep Study Requisition
Respiratory | Referral Forms
For more information, please call the Sleep Laboratory at 416-243-3631 or sleeplab@westpark.org. View
Spasticity Clinic Referral Form
Neurology | Referral Forms
For admission information, please call the Admitting Department at West Park Healthcare Centre at 416-243-3632, or email admitting@westpark.org View
TB Service Inpatient Referral/Application Form
Respiratory | Admission Forms
Please download this form and contact the TB Service directly at 416-243-3600 x4626. View
TB Service Outpatient Referral/Application Form
Respiratory | Admission Forms
Please download this form and fax it to 416-243-3696. The TB Service Outpatient Service can be contacted at 416-243-3600 x2180. View
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