Toronto Central region referral for home and community care services.
- Completed by
- Referring physician or NP (referral source may be another provider)
- Issued by
- Ontario Health atHome
- Format
- Fillable PDF
- Language
- English
Ontario Health atHome Referral Forms by Region
Ontario Health atHome has no single provincial referral form: each of its 14 regions posts its own general referral form for providers sending patients to home and community care. Clinicians use them to request services and give treatment orders and their own details. After processing, Ontario Health atHome phones the patient and connects them with a care coordinator or a community program.
Who completes it
The referring physician, nurse practitioner or other provider completes the referral source, requested services and treatment orders, and their own details and signature, with the layout varying by region. Anyone, including family members, can also refer a patient with the patient's consent.
Submitting and payment
- How to submit it
- Fax the form to the regional Ontario Health atHome office using the number printed on that region's form, or refer by phone through Ontario Health atHome's central referral line.
Good to know
- The regions are Erie St. Clair, South West, Waterloo Wellington, Hamilton Niagara Haldimand Brant, Central West, Mississauga Halton, Toronto Central, Central, Central East, South East, Champlain, North Simcoe Muskoka, North East and North West.
- Regional names differ: Waterloo Wellington uses Form 031, Request for Services, with Form 031B for hospice palliative care, and Central East uses a Request for Assessment Form.
- Champlain's community referral form lists eligibility for direct services as a valid OHIP card and an assessment by a health care professional.
- Ontario Health atHome's website identifies the region from an Ontario postal code, and its Document Library holds other program-specific referral forms.
Get the official form
Download the current version from the source each time; forms change without notice.
Ontario Health atHome referral forms (by region)
Fill it with Vero
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Frequently asked questions
Is there one Ontario Health atHome referral form for the whole province?
No. Ontario Health atHome posts 14 regional general referral forms under For Health Care Providers on its Making a Referral page. Use the form for the region where the patient lives; the website can identify the region from an Ontario postal code, and each form carries its own fax number.
Who can refer a patient to Ontario Health atHome?
Anyone can make a referral on a patient's behalf with their consent, including family doctors, family members, friends, caregivers and neighbours. Providers can use the regional forms, and anyone can refer by phone. Once the referral is processed, Ontario Health atHome calls the patient to follow up.