Forms

    Admission/Referral Forms and Applications

    For Your Convenience

    Forms

    If you do not have access to the Resource Matching and Referral (RM&R) electronic information and referral system, we have made available for download a selection Referral Forms as PDF files. These forms must be printed, completed and signed by a referring physician and faxed back to our Admitting Department at 416-243-8947.

    Note: Consult and therapy notes must accompany all referral forms. Additional information may be required prior to admission to the Centre.

    If you require any assistance in filling out a particular form or need further information regarding admission to West Park, please call 416-243-3626.

    General Rehab CCC Inpatient Referral Form
    Referral Forms
    For admission information, please call the Admitting Department at West Park Healthcare Centre at 416-243-3632, or email admitting@westpark.org View
    Pulmonary Function Exercise Test
    Respiratory | Referral Forms
    For more information, please call the Sleep Laboratory at 416-243-3631 or sleeplab@westpark.org. View
    Respiratory - CAVC Inpatient Pre-Assessment Referral Form
    Respiratory | Referral Forms
    For admission information, please call the Admitting Department at West Park Healthcare Centre at 416-243-3632, or email admitting@westpark.org View
    Respiratory - Respiratory Rehabilitation
    Respiratory | Referral Forms
    For admission information, please call the Admitting Department at West Park Healthcare Centre at 416-243-3632, or email admitting@westpark.org View
    Respiratory - Transitional Home Ventilation Inpatient Pre-Assessment Referral Form
    Respiratory | Referral Forms
    For admission information, please call the Admitting Department at West Park Healthcare Centre at 416-243-3632, or email admitting@westpark.org View
    Seniors Mental Health Service Referral Form
    Seniors' Services | Referral Forms
    Please download this form and contact the Seniors Mental Health Service at 416-243-3732. View
    Sleep Study Requisition
    Respiratory | Referral Forms
    For more information, please call the Sleep Laboratory at 416-243-3631 or sleeplab@westpark.org. View
    Spasticity Clinic Referral Form
    Neurology | Referral Forms
    For admission information, please call the Admitting Department at West Park Healthcare Centre at 416-243-3632, or email admitting@westpark.org View
    TB Service Inpatient Referral/Application Form
    Respiratory | Admission Forms
    Please download this form and contact the TB Service directly at 416-243-3600 x4054. View