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Grand River Hospital (GRH) has 15 clinical programs and services to care for the members of our community.

Below is a list of referral forms for you to refer patients for care. 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 (PDF format unless stated otherwise)

Children's Program
Childbirth Program

Complex Continuing Care and Rehabilitation

Communication technology clinic:
EMG Testing
  • EMG: KW Campus
  • EMG: Freeport Campus (updated 2024)
Medical Imaging
Mental Health and Addictions
Neuro Rehabilitation Clinic
Outpatient Procedures
Palliative Care
Prosthetic and Orthotic Clinic
Renal (Kidney) Care
Stroke Care

Transition Care Unit - Referral Form

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 share the following with your patients before their visit to GRH.

Please inform your patients:
  • who their appointment is with;
  • the date of their appointment;
  • what time they need to arrive for their appointment; and
  • where campus their appointment is at.
Please advise patients to bring the following items to their appointment:
  • 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.