Physician Referral

Our Certified Orthotists will spend time with each patient to assess and determine appropriate treatment plans with regard to orthotic intervention.

To refer your patient, please complete this Physician Referral Form, then save it and attach it to an email to lindalaakso@customorthotic.ca.

Or you can print it and fax it to (905) 828-1091.

Once we have completed our assessment, we will provide you with a comprehensive report recommending suitable interventions including bracing, footwear and other treatments.

Thank you!