Healthcare Referral

Healthcare Referral Form

This form is for healthcare organizations and professionals who wish to refer their patients/clients to CanCare for emotional support services.

If you are not a healthcare provider, please go to www.cancare.org/support to self-refer.

The information you provide is treated as confidential and used by CanCare staff to address your patient's needs.

It will only be provided to your patient's dedicated volunteer so they can connect with your patient and support their needs. See CanCare's privacy policy for more detail.

Please provide as much detail as possible to ensure the best match for your patient/ client.

Need help? Contact our Matching Team at matching@cancare.org or 346-421-5777.