Patient Self-Referral Guide

Begin your intake for Hyperbaric Oxygen Therapy in Barrie. Approved conditions are 100% OHIP-covered, and patients can self-refer directly to our clinic.

Download / Print Form

Patient Information

First Name *

Last Name *

Date of Birth

Primary Phone Number *

Patient Email Address

OHIP Number including Version Code

Primary Care Physician (name and fax)

Reason for Referral *

Referring Physician Information (Optional for Self-Referral)

Provider Name

CPSO Number

OHIP Billing Number

Clinic/Hospital Name

Phone Number

Fax Number

Current MRP for wound care (if applicable)

MRP Phone

Supporting Documents

Please remember to manually attach any supporting documents (Consult notes, Bloodwork, X-rays, etc.) to the email that will be generated when you click submit.

This will open your default email client with the form details securely pre-filled.

Patient Self-Referral Guide

Patient Information

Reason for Referral *

History

Referring Physician Information (Optional for Self-Referral)

Supporting Documents