Referrals for Gender-affirming care with Dr Cynthia Chan
REFERRAL FORM LINK:
Doctors must send a completed referral form to the attention of Dr Cynthia Chan via fax 613 828 4895
All referrals will need to be from a clinician using this referral form before appointments can be booked.
Dear health care providers,
We are so pleased to be able to offer this new service at our clinic! Please use the attached referral form and fax to Dr Cynthia Chan. Incomplete forms may result in delays in booking.
Dr Chan is family physician who does not have a focused practice designation. This may result in financial penalties to family physicians in FHO settings for patients to see her. Please indicate in the referral form if you would like her to provide ongoing follow-up to your patient, or if you would like to take over providing gender affirming care following initial consultation with her.
Please inform your patient that when their referral has been received, your patient will receive an Ocean communication with a mandatory intake form. They do not need to contact the clinic prior to receiving the intake form.
After they complete the intake form, our office will contact your patient to book an intake appointment (appointment time approx 60 minutes). If necessary information is missing from the intake form, they may not receive an appointment, so please ask them to complete it to the best of their ability. Please also inform your patient that there will be a no show fee if they miss their appointment without 48 hours of advanced notice.
Please see the attached referral form: