Patient Referral

Online Referral Form

Submit a patient referral to our team - securely and in minutes. We’ll contact your patient directly within 24 - 48 hours to confirm their appointment.

Patient Referral

Online Referral Form

Please complete all required fields marked with *. Your patient will be contacted within 24 - 48 hours to schedule their appointment.

Patient Information
Referring Provider Information
Services Requested
Injury / Condition Details
Insurance Information
Documentation

Upload Referral / Prescription (Optional)

Most patients are contacted within 24 - 48 hours.
Direct billing available for most insurance plans.

Unit 2, 100 Highland Rd W, Kitchener, ON N2M 3B5
Get Directions

Start Moving Better Today

From pain relief to full rehabilitation, Apollo Physiotherapy & Rehabilitation is here to support your recovery journey.

Book Now