Health professionals

Patient Referral for Electrotherapy

This section is reserved for clinics that wish to refer electrotherapy patients to us. Please send us a scanned version of your completed referral form.

Option

Digital file

Online Patient Referral for Electrotherapy.

Proceed

Please attach a PDF, scan or photo of patient's referral form and medical prescription :

Patient’s Contact Information

Clinic’s Contact Information

Please attach patient's medical prescription :