REQUEST AN ASSESSMENT

Start a referral

This form captures everything we need to confirm and book — without extra back-and-forth. We’ll respond within two business hours.

1. Referral source information

Who should we coordinate with on this file?

Full Name *

First

Last

Email address *

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Organization / firm name *

Phone Number *

Your role *

2. Assessment details

What do you need, and how soon?

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Assessment type requested *

Urgency level *

Medical specialty required (if known)

Specific questions to be addressed

3. Claimant / assessee information

We'll contact them directly to schedule, with care.

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Claimant full name *

Contact Phone Number *

Date of Birth *//

Preferred Location

Document Uploads

Click or drag files to this area to upload. You can upload up to 8 files.

Please upload any documents relevant to your assessment request, such as medical records, specialist reports, diagnostic imaging, previous assessments, or referral documentation.

Additional notes or context

Your privacy, protected. Referral and claimant information is handled in accordance with PIPEDA and applicable provincial privacy legislation. Information is used solely to coordinate the requested assessment and is never shared with third parties.