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Waterloo Regional Diabetes Education Programs –Central Intake

Please fill out the following information and fax back...- If possible, please attach recent blood work results and/or a list of up to date medications you are taking...Do you give permission to...
https://www.wwhealthline.ca/pdfs/Healthy-Living_Community-Diabetes-Program_Self-Referral-Form.pdf

Waterloo Regional Diabetes Education Programs –Central Intake

Please fill out the following information and send along with recent blood work results and/or a list of up-to-date...medications you are taking, if possible....Do you give permission to contact...
https://www.wwhealthline.ca/pdfs/Diabetes_Self_Referral_Form.pdf

Waterloo Wellington Specialized Geriatric Services Referral Form

older patient's mental health in order to and treatment recommendations. ...Typical...provide accurate diagnosis and treatment concerns include balance and falls...options. ...Symptoms may include...
https://www.wwhealthline.ca/pdfs/WW_SGS_ReferralForm_Fillable.pdf

Cardiodiagnostics Services Requisition Form

... followed and managed by...a Cardiologist. ...In this case, either refer directly to that physician’s office or order a test only, with the results copied to...the patient’s usual Cardiologist
https://www.wwhealthline.ca/pdfs/Cardiodiagnostics-Services-Requisition-Final-June-2016.pdf