Diabetes Clinic

Health-care Providers

Please use the below form to refer your patients. Referrals must be submitted by a medical doctor 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.