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For referring clinicians

Refer a patient

Please fill out the online referral form below. Alternatively, you may download the PDF referral form and fax it to 250-739-5530.

Patient information

Format: (000) 000-0000.

Referrer information

Format: (000) 000-0000.

Clinical information

Diagnosis

Select at least one.

Optional unless Other is selected as a diagnosis.

Treatment considerations

Treatment options

Select at least one.

Potential contraindications to TMS treatment

Screening prompt only. Selecting an item does not determine eligibility.

Potential contraindications to ketamine therapy

Screening prompt only. Selecting an item does not determine eligibility.

Thank you for your referral

We sincerely appreciate your trust in NeuroLinks. Your referral has been received, and our clinical team will review it with care and attention.

If you have any questions or would like to share additional information, please contact NeuroLinks through our usual office channels. We're here to help make the referral process as smooth as possible.

Thank you for partnering with us in caring for your patient.

Submission confirmation

Your submitted referral

This is a copy of the information submitted through the online referral form.

Patient information

Patient name
Not provided
PHN
Not provided
Patient phone number
Not provided

Referrer information

Referrer name
Not provided
MSP number
Not provided
Referrer phone number
Not provided
Fax number
Not provided

Clinical information

Diagnosis
None selected
Clinical details
Not provided

Treatment considerations

Treatment options
None selected
Potential contraindications to TMS treatment
None selected
Potential contraindications to ketamine therapy
None selected
Other important information
Not provided