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Referral Forms

Our Neurology specialists accept referrals from your family physician.
Download the Physician Referral form below and fax to 587-332-0601 or email it to info@mykidz.ca once completed.

Other general clinical forms are also available below to download.

Physician Refferal Form (pdf)

Medication Record Forms (pdf)

Release of Patient Information (pdf)

Pediatric Neurology Questionnaire - v1.4 (pdf)