Referral Form Agency

Healthcare providers looking to refer their clients to the Alzheimer Society can complete our online referral form below. Our First Link team will connect your clients to appropriate services including education and counselling.

Senior couple filling out a form with an advisor.

Healthcare providers can make a referral for their clients using one of these methods:

  • Complete our online referral form below
  • Download our fillable referral form and fax to 905-687-9952
  • Phone our office at 905-687-3914

Healthcare Providers Referral From

Referral Form Family

Making a referral is easy, fill out the form below and let us take care of the rest. You will receive a call from our staff who will create an individualized care plan including education, support and social recreation programs.

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Senior couple filling out a form with an advisor.