Patient Referral Form

If you are a physician from Sick Kids referring to the new onset seizure clinic, please do not use this referral pathway. Please submit your referral HERE. 

Name
MM slash DD slash YYYY
Address

Physician Information

Name

Patient history and reason for referral
Referral services requested
Preferred to be seen for appointment

If you are a physician from Sick Kids referring to the new onset seizure clinic, please do not use this referral pathway. Please send your referral at the link below. 

Patient Referral

Submit by Email or Fax

Request for Consultation – Referral Form (PDF)

Send referrals to:
Email: admin@neurologycentretoronto.com
Fax: 416-860-7559

Virtual Rapid Access Clinics

Visit www.nctvirtual.com to learn more.

Same-Day Appointments Possible.
Virtual Walk-In Style.

If you are a physician from the Hospital for Sick Children then click here for referrals for the New Onset Seizure Pilot Project.