Home Referral Forms

Referral Forms

Choose the patient’s service and region to download the current MedPro referral form.

Respiratory Services Referral Forms

Use these regional requisitions to refer patients to MedPro for respiratory services and support. Choose the form for the region where the patient will receive care; submission instructions are included in each PDF.

Alberta South

Respiratory Services requisition

Download PDF

Alberta North

Respiratory Services requisition

Download PDF

British Columbia

Respiratory Services requisition

Download PDF

Ontario / GTA

Respiratory Services requisition

Download PDF

Additional Equipment Form

Respiratory Equipment Requisition

For hospitals, family physicians, long-term care facilities, and other healthcare providers referring patients for respiratory equipment, rentals, purchases, or replacement supplies.

Suction Equipment Rental or purchase equipment, suction catheters, and Yankauer devices.
myAirvo 2 Therapy Heated humidification equipment and compatible tubing, chambers, cannulas, and interfaces.
Nebulizer Therapy Aerosol medication equipment and supplies, including Tobramycin therapy support.
Tracheostomy Supplies Tubes, speaking valves, cleaning supplies, ties, gauze, and related items.
Download PDF

Home Sleep Apnea Testing Referral Form

Use this requisition to refer patients for home sleep apnea testing through MedPro. Select the British Columbia region where the patient will receive service before downloading and submitting the current form.

BC Interior

Home Sleep Apnea Test requisition

Download PDF

BC Lower Mainland

Home Sleep Apnea Test requisition

Download PDF

BC Vancouver Island

Home Sleep Apnea Test requisition

Download PDF

Respiratory Services: Follow the fax and submission instructions shown on the selected PDF.

Home Sleep Apnea Testing: Email completed forms to HSAT@medprorespiratory.com. Follow your organization’s privacy requirements and do not include patient information in the email subject line.

Questions? Call 1-888-310-1444 before submitting. Do not send patient or referral information through MedPro’s general contact form.