Get Baycrest Memory Clinic Referral Form

This guide provides a clear and comprehensive overview of how to complete the Baycrest Memory Clinic Referral Form online. By following these steps, you can ensure that all necessary information is accurately submitted for the referral process.

Follow the steps to successfully fill out the referral form.

1. Press the ‘Get Form’ button to access the referral form and open it in the editor.
2. Fill in the client's name and date of birth. Ensure the format is accurate to prevent any delays in processing.
3. Indicate the marital status of the client from the available options.
4. Provide the street address, including the apartment number if applicable, along with the province, city, and postal code.
5. Enter the client’s health card number and daytime and evening phone numbers.
6. Identify the name of the person to contact regarding appointment bookings and their relationship to the client, along with their phone numbers.
7. Indicate if the client is fluent in English. If not, specify the language spoken at home.
8. Select the reason for referral by checking the relevant boxes for memory, language, or behavioral issues, including any additional clinical concerns.
9. Provide the necessary recent blood work results and list any prior medical reports required by the clinic.
10. Complete the sections for current medications and any additional comments that may assist the clinician.
11. Finally, fill in the names and contact information for the family doctor and referring doctor. Note the date on which the referral is being made.
12. After completing the form, ensure all information is accurate, and then save your changes. You can download, print, or share the form as needed.

Begin the process and complete your referral form online today.