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Crocus Care Referral Process


To protect confidentiality of your client the referral forms can be submitted by fax, email or in-person. If you are not sure about which coverage you fall under, please feel free to choose the "Free Consultation" option. We will determine your eligibility upon your first visit.

Referral Form Can be

  • Downloaded and electronically filled

  • Printed and completed by hand

  • used MDs, NPs, RNs and other providers

  • used Patient for self-referral

Our fax: 613-216-2156

Download Referral Form (PDF)
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