Central Intake - COMMON REFERRAL FORM- DIABETES

The Mississauga Halton Central Intake Program in partnership with community Diabetes Education Programs in Mississauga Halton, have created the Diabetes Common Referral form to replace all program specific referral forms.

The Central Intake Program will triage each referral to the most appropriate program depending on the needs of the patient and location closest to their residence.

Specific Program Requested: Please indicate under ‘patient preferred location’ on the referral if there is a specific program you would like your client to be routed too.

Diabetes Education Common Referral Form