Referring Professionals

Download Our Printable Referral Forms

We welcome collaboration with physicians, therapists, and other healthcare professionals who believe in integrated healthcare and want to achieve the best outcomes for their patients. Our team will work with you to understand patient needs, deliver detailed movement analysis from our cutting edge laboratory, and deliver the best possible care for your patients. Download the appropriate form and submit it to our clinic either by email, fax, or with your patient.

Adult Orthotic Referral Form

Documentation to be completed by a physician or healthcare professional to request orthotic services for an adult patient.

Paediatric Orthotic Referral Form

Documentation to be completed by a healthcare professional to request orthotic services for a child who needs a brace or support device.

Or, Use Our Digital Referral Form

Use this form to quickly and securely refer a patient. We’ll follow up to coordinate intake, ensure all necessary documentation is received, and streamline any administrative tasks like medical file transfers or insurance details. Our team is committed to making the referral process efficient and collaborative, so you can stay focused on patient care while we handle the logistics.

"*" indicates required fields

Physician Information

Name*

First Name * Last Name *

Email*

Phone*

Fax

Patient Information

Name*

First Name * Last Name *

Health Card Number

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Referral Notes

Diagnosis / Dx.*

History / Hx.

Digital Signature*

By uploading my signature and submitting this form, you confirm that all information provided is accurate to the best of your knowledge. All details submitted will remain confidential and will be handled in accordance with patient–doctor confidentiality standards.

Max. file size: 300 MB.