Referral Form
Submit a professional referral to Supreme Medical Clinic online. This form is for referring healthcare providers — patients should use the New Patients page instead.
Prefer to Send by Fax?
Complete referrals can be faxed to 416-247-7393, referencing the patient's name and date of birth.
Download the Fillable PDF
Download the clinic's official referral form, fill it in using Adobe Reader or your browser's PDF tool, then fax or email it back to the clinic.
Download Fillable PDFOr Submit Online
Complete the form below directly on this page. You'll be able to download a PDF copy of what you submitted once you're done.
Emergency Notice
The Referral Form is not for emergencies or crisis intervention. Call 911 for immediate danger or urgent medical assistance. Call or text 9-8-8 for suicide-crisis support.
Administrative Assistance
For questions about the form or submission process:
Telephone: 416-477-6090
Fax: 416-247-7393
Email: contact@suprememedicalclinic.ca