Grand River Hospital (GRH) is the largest hospital in the region. We offer 15 clinical programs and services to care for the members of our community.

Below is a list of referral forms for you to refer your patients for care at GRH. These forms must be completed by a health care professional (i.e. doctor).

If you’re a member of the community and feel that you should be referred for one of these services, please speak with your health care provider.

Referral forms

Unless otherwise stated, referral forms are in PDF format.

Children's Program
Childbirth Program

Complex Continuing Care and Rehabilitation
Communication technology clinic:
Neuro Rehabilitation clinic:
Prosthetic and Orthotic clinic:
Palliative Care
EMG Testing
Medical Imaging
Mental Health and Addictions
Outpatient Procedures
Renal (Kidney) Care
Stroke Care

Grand River Regional Cancer Centre

If you would like to refer a new patient to the Grand River Regional Cancer Centre/Waterloo Wellington Regional Cancer Program diagnostic assessment programs or would like more information, contact our new patient referrals office at 519-749-4370 extension 5720.

Preparing your patients

Please ensure you prepare your patients for their visit to GRH. Coming prepared and knowing where to go will help ease the anxiety many patients feel when coming to the hospital and ensure they arrive on time.

Please inform your patients:
  • who their appointment is with;
  • the date of their appointment;
  • what time they need to arrive for their appointment;
  • where their appointment is; and
  • how to get to their appointment (directions, parking, etc).

Please advise them to bring the following items to their appointment:

  • Their health card;
  • A list of medications they are currently taking;
  • Test results from another doctor or hospital (if applicable);
  • A family member or support person; and
  • A list of questions that they wish to have answered during their visit.

Sending a patient to Grand River Hospital from another facility

This information is intended for other facilities transferring a patient to Grand River Hospital through the bed allocation department.

Guidelines for transfer

Transfer of Information (TOI) form

International patient referrals

Non-Ontario residents and residents without Ontario health insurance are considered self-pay patients. Self-pay patients are required to meet eligibility criteria, complete self-pay financial forms and follow a standard admitting process to be considered to receive care at GRH.

Our patient access and flow department manages all international referrals/requests and supports our patients and families through the application process and delivery of care. All applications are reviewed by our health care professionals to determine if care can be provided at GRH.

For more information regarding an international patient referral, please contact 519-749-4300 extension 4434.