Patient Referral

Online Referral Form

Choose the option that works best for you - Download our Patient Referral Form to complete offline, or fill out the secure online referral form below. We’ll contact your patient within 24–48 hours to arrange 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.

Now Accepting New Patients

Looking for Physiotherapy in Kitchener?

Whether you’re recovering from a sports injury, concussion, neurological condition, workplace injury, or motor vehicle accident, we’re here to help. Book your assessment today.

Proudly serving Kitchener, Waterloo, Cambridge, Guelph, and nearby communities.

Unit 2, 100 Highland Rd W, Kitchener, ON N2M 3B5
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From pain relief to full rehabilitation, Apollo Physiotherapy & Rehabilitation is here to support your recovery journey.

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