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Referral Forms

How to Become a Patient

We accept referrals from primary-care physicians (family doctors) and nurse practitioners, as well as patient self-referrals. Patients are asked to bring a current medication list, blood glucose metre, and logbook (if available) to each visit to Southlake's Diabetes Education Centre. 

Primary care physicians or nurse practitioners: click to access the Primary Physician Referral Form
Patients who wish to make a self-referral: click to access the Self Referral Form

Please fax all referral forms to: 905-853-3180

For more information, or to schedule an appointment, please contact: 905-895-4521, ext. 5650.

Southlake Regional Health Centre
596 Davis Drive, Newmarket, Ontario   L3Y 2P9
Tel: 905-895-4521   |   TTY: 905-952-3062
Copyright © 2012 Southlake Regional Health Centre
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