Let’s work together.

Physicians/Practitioners please find our referral form below.

Referrals are NOT REQUIRED for our services

Patient Name

First Name

Last Name

Patient Phone

(###)

###

####

Patient Email

Service(s) Required

Chiropractic Care

Physiotherapy

Pelvic Floor Therapy

Massage Therapy

Acupuncture

Custom Orthotics

Other

Details

Please provide all relevant details and injury concerns

Referring Practitioner

Please provide the name of the referring physician/practitioner

First Name

Last Name

Field Of Practice

Name of Practice

*To attach any additional documents, please email us at info@saharahealth.co or send us a fax at 905-225-0256

Open 7-Days a week