Refferal - Erika Pharand, Dt.P. Nutritionniste-Diététiste

Erika Pharand, Registered Dietitian-Nutritionist, aims to make the patient referral process as simple and convenient as possible for healthcare professionals. Please complete this form, and I will reach out to your patient promptly.

Whether you are a physician, nurse, physiotherapist, psychologist, psychotherapist, kinesiologist, or another healthcare professional, a referral to a dietitian-nutritionist can support a comprehensive, collaborative approach to your patient’s care.

Patient & Healthcare Professional Information

Patient First and Last Name

Referring Healthcare Professional Patient First and Last Name

Patient Date of birth

Referring Healthcare Professional Fax number

Patient Phone Number

Referring Healthcare Professional Email Address

Patient City

Referring Healthcare Professional Professional license number

Reason for consultation

Relevant health information or clinical details

New Field New Field I would like to receive confirmation once the patient has been contacted and care has been initiated.

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