Patient Referral Forms

For your convenience and ease of patient referral, we have provided fillable and printable referral forms here in Adobe Acrobat PDF format. The Adobe Acrobat Reader is FREE and can be downloaded at

Referral forms are for Level III Home Sleep Studies with medical interpretation and/or Sleep Therapy Consultation from Physicians, Naturopathic Physicians, Nurse Practitioners, Dentists, CPAP Providers, Physio/Occupational and Chiropractic Therapists and other Auxiliary Health Care Providers. Prescription forms for Oral Appliance Therapy are also provided below if needed. If you have a patient to refer and are unclear please feel free to use the main referral for appliance therapy form or call/email us with your questions.

PATIENTS can self refer without a referral form by contacting us or scheduling online.

Please complete and print these forms for any patient you wish to refer and fax to (604) 987-5336 or email to for NORTH VANCOUVER office or (604) 587-5336 or email for SURREY office