Synergy Sport + Mental Health

FORMS

(519) 837-1228

Physician Referral

202-511 Edinburgh Road South

Guelph, ON N1G 4S5

Physician referral form instruction: The form can be printed, completed and faxed by the referring physician, or a letter of referral can be generated by the physician themselves if preferred. Information required for referral include the patient's name, address, contact information, date of birth, reason for referral, and the physician's OHIP billing number.
Individuals without provincial health insurance can also access services but will be required to pay privately or through benefits.