Carbohydrate Counting Group Class

Health-care Providers

Please use the below form to refer your patients. Referrals must be submitted by a medical doctor or interprofessional staff and are required if the patient has not been seen by our program in the past year.

Diabetes Education Referral Form

Please include the following with your referral.

• Services requested (i.e., one-to-one education, clinic and/or group class).
• Health-care professionals requested (e.g., nurse, dietitian, endocrinologist). Note: Assistance with insulin adjustments can be made by the nurse/dietitian if physician authorization is included on the referral form.
• Relevant labs.

Completed referral forms and labs should be sent by fax to 416-530-6050