Form for Physicians
Click the download button to automatically save the requisition to your computer
* If the download does not start automatically, manually save the file by clicking the download icon in the top-right corner of the pdf viewer.
Open the PDF file on your computer using a PDF editing program (e.g., Adobe Acrobat, Microsoft Office) to complete your patient's information digitally.
If you don't have access to the PDF editing software or prefer not to fill out the form digitally, print the requisition, complete it by hand, and scan the completed form.
Once the form is completed:
Fax it to us at +1 (289) 722-2023, or
Provide the requisition to the patient to bring in person
Alternatively, the patient can text us a photo of the requisition at (905) 897-6970.