Offline Self Referral
Click this link: Self Referral PDF to open a pdf version that you can fill out and print. To fill out the pdf just click on the field (anything underlined) and type your answer. When you are ready to print out the document just look for your browser’s print button.(The PC’s short cut for print is press both “crtl” and “P” keys at the same time.) If you wish you may also fill the form out by hand, just open the pdf link and print it out. If you choose to not fill out the form online; please submit the completed form either through fax at 519-584-0770 or send in the form to the clinic. The clinic is located at 430 The Boardwalk, Suite 308-B Waterloo, Ontario, N2T 0C1.