Referral Forms
These forms are periodically modified. To make sure you are using the most current version, please download it from this webpage.
NOTE: For all referrals (excluding referrals to ABI rehab), please fax referral forms directly to the programs being requested. Program details and contact information can be found through Rehab Finder.
| Referrals to Inpatient Rehab/CCC | |
| Acquired Brain Injury Rehab Referral | Use this link to access the referral form and instructions for where to fax the completed referral form for ABI inpatient rehab. |
| GTA Rehab Network Integrated Acute Care to Inpatient Rehab/CCC Referral Form (June 2026) | Use this form to refer patients to inpatient (bedded) rehab/CCC programs provided by member organizations of the GTA Rehab Network. The form includes referral information pertinent to COVID-19 (Note: Not used for stroke patients.)
NOTE: Fax completed referrals directly to the program/service you are requesting as per the organization’s intake process. Information on the application process is available on Rehab Finder. For details on completing the form, see Reference Guide for Completing Inpatient Rehab/CCC Referrals. |
| GTA Rehab Network Emergency Department to Inpatient Rehab Referral Form (July 2025) | Use this form for referrals directly from the emergency department to inpatient (bedded) rehab/CCC programs. This form is designed to be briefer than the standard Acute Care to Inpatient Rehab/CCC referral form, allowing for relevant ED assessments/consults to accompany the referral.
NOTE: Fax completed referrals and relevant ED assessments/consults directly to the program/service you are requesting as per the organization’s intake process. Information on the application process is available on Rehab Finder. For details on the process for referring from the emergency department to inpatient rehab, see Direct Access Emergency Department to Inpatient Rehab Process Map. |
| eStroke Acute to Inpatient Rehab Referral Form (April 2023) | Use this form for stroke referrals for organizations that do not have access to the eStroke Rehab Referral System. |
| Referrals to Outpatient/Ambulatory Rehab |
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| Acquired Brain Injury Outpatient Rehab Referral Form | Use this link to access the referral form and instructions for outpatient and community-based referrals. |
| Outpatient/Ambulatory Rehab Referral (PDF) (Rev. Jan 2026)
Outpatient/Ambulatory Rehab Referral (Fillable) (Rev. Jan 2026) |
Use this form for all rehab populations except total joint replacements and acquired brain injury. (See separate sections for instructions on these populations.) The form may be completed online, printed and faxed OR printed, completed by hand and faxed. |
| E-Stroke Outpatient Rehab Referral Form (April 2023) | Use this form for stroke referrals from acute care organizations that do not have access to the E-Stroke Rehab Referral System. |
| Outpatient Referrals for Hip, Knee & Shoulder Replacement/Revision | |
| Outpatient Rehab Referral for Hip, Knee or Shoulder Surgery (PDF) (March 2023)
Outpatient Rehab Referral for Hip, Knee or Shoulder Surgery (Fillable) (March 2023) |
Use this outpatient rehab referral form for hip, knee and shoulder replacement or revision provided by member organizations of the GTA Rehab Network. |
| Listing of Outpatient Rehab Programs that Accept Hip, Knee or Shoulder Surgery External Referrals (September 2025) | This comprehensive listing identifies outpatient rehab programs across the GTA that will accept external referrals for outpatient rehab following hip, knee and shoulder replacement or revision. |
