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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 can click here to access the Primary Physician Referral Form
Patients who wish to make a self-referral can click here 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