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Healthcare Provider Forms
Referral Forms for Healthcare Providers
Access current MedPro respiratory-service and Home Sleep Apnea Testing requisition forms. Select the appropriate service and region below, complete the form and follow the applicable submission instructions.
✓ Fillable requisition forms
✓ Organized by service and region
✓ Submission instructions provided
Before You Submit
Three Steps to Send a Referral
1
Choose the Correct Form
Select the service and region that apply to your patient.
2
Complete the Requisition
Provide the required patient, clinical and referral information.
3
Follow the Submission Instructions
Send the completed form using the instructions for that referral pathway.
Respiratory Services
Respiratory Services Requisition Forms
Select the requisition for the patient’s applicable region. Complete the fillable form and fax it to the number listed at the top of the form.
Alberta
Alberta South
Respiratory Services requisition for patients accessing applicable MedPro services in Southern Alberta.
Alberta
Alberta North
Respiratory Services requisition for patients accessing applicable MedPro services in Northern Alberta.
British Columbia
British Columbia
Respiratory Services requisition for applicable patient referrals in British Columbia.
Ontario
Ontario / Greater Toronto Area
Respiratory Services requisition for applicable patient referrals in Ontario and the Greater Toronto Area.
Respiratory Services submission: Complete the appropriate fillable requisition and fax it to the fax number listed at the top of that form.
Home Sleep Apnea Testing
Home Sleep Apnea Testing Requisition Forms
Select the requisition for the patient’s applicable British Columbia region and complete the required referral information.
Submit completed HSAT requisitions to:
British Columbia
BC Interior
Home Sleep Apnea Testing requisition for applicable patients in the British Columbia Interior.
British Columbia
BC Lower Mainland
Home Sleep Apnea Testing requisition for applicable patients in the British Columbia Lower Mainland.
British Columbia
BC Vancouver Island
Home Sleep Apnea Testing requisition for applicable patients on Vancouver Island.
Referral Support
Not Sure Which Form to Use?
The appropriate referral form can depend on the requested service, patient location and applicable regional requirements.
If you’re unsure which referral pathway applies, contact MedPro before submitting the referral.
Helpful Information to Have Ready
- Patient’s province and region
- Requested respiratory or sleep service
- Relevant referral or prescription information
- Referring healthcare professional information
- Relevant clinical information required by the form
- Applicable funding or coverage information, when required
Healthcare Provider Support
Need Additional Referral Support?
Visit our Healthcare Providers page for information about MedPro’s respiratory-care pathways, referral process and patient support.