Referral Forms for Healthcare Professionals
This page is intended for physicians referring patients who reside in Canada, outside the province of Ontario.
To access the page for patients living in Ontario, click here
You can refer your patient using either of the following methods:
Online Referral - Complete and submit the referral form below.
Fax Referral - Download the referral form and fax it to 1-833-830-9098.
Prescription Referral- Provide your patient with a prescription and instruct your patient to contact us.
Once the referral is received, our support team will contact the patient directly to arrange access to the test.
Please note: This medical test is a private service and is not covered by the provincial health insurance.
Online Referral Form
Your information will be sent securely and treated with confidentiality.