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Referral Form

CArE OP Referral Form 

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  • CArE OP Referral Form 

Patient Information

Address(Required)
Date of Birth(Required)

Physician Information

Address
Signature
PLEASE NOTE THAT PATIENTS WILL BE SEEN BY ONE OF OUR INTERDISCIPLINARY HEALTH PROFESSIONALS AND WILL SEE A RHEUMATOLOGIST ONLY IF DEEMED APPROPRIATE. CArE DOES NOT ACCEPT REFERRALS FOR SECOND OPINION OR TRANSFER OF CARE.
Reason for Referral (select one or more)
Osteoporosis (OP) Medication(s):

Before sending referral, please be sure you have included:

  • Bone mineral density test results within past 24 months and all previous available
  • Relevant imaging results e.g. x-rays thoraco-lumbar spine, fracture(s)
  • Past medical history, current medications and any relevant consultation notes
  • Recent blood work results including: Calcium (corrected for albumin), Phosphate, SCr (eGFR), ALP, TSH, SPEP (for patients with vertebral fractures), 25-hydroxyvitamin D (if risk factors for insufficiency or starting potent antiresorptive)
Max. file size: 2 MB.
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