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Requisition Forms

Welcome to Physiologix! We look forward to providing your with the highest quality comprehensive care available. We have several requisition forms to meet your individual needs.

Learn more about our Medical Specialists, Diagnostic Imaging, and  Physio and Allied Health Services.

Physio & Allied Health 

Please use these forms to refer to our Physio and Allied Health professionals including Physical Therapy, Massage Therapy, Acupuncture, and Psychology. Please fax referrals to 1-833-44FAXPX (1-833-443-2979). We will contact the patient directly upon receipt. 

Diagnostic Imaging & Interventional Pain Management

Please use this tick-box user-friendly form to refer patients for Diagnostic Imaging services including X-ray, Ultrasound, and Pain Management. You can fax the requisition to 1-833-44FAXPX (1-833-443-2979) or have the patient call us at 1-833-4CALLPX (1-833-422-5579).

All-In-One Requisition

To refer your patient to any of our services (Medical Specialists, Diagnostic Imaging, and/or Physio and Allied Health), feel free to use the All-In-One Requisition Form and fax it to 1-833-44FAXPX (1-833-443-2979).

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