Palliative Care Physician Referral Forms

Inpatient consult

To access a palliative care inpatient consult, the Most Responsible Physician (MRP) orders a consult through Cerner. If urgent, the MRP should page the palliative doctor on call through locating at ext 6002.

Pain and Symptom Management Clinic 

To access a Pain and Symptom Management Clinic consult, fax the Pain and Symptom Management Clinic Referral Form to 416-756-6833.

Supportive care 

To access a Supportive care consult, fax this Supportive Cardiology Clinic Referral Form to 416-756-6472.

Outreach 

For an outreach or “home-based” palliative care consult, fax this Palliative Care Common Referral Form to 416-756-6024. The Freeman Centre offers in-home palliative care for adults living with advanced cancer within the catchment areas: south of Steeles Ave., north of Lawrence Ave., west of Victoria Park Ave., and east of Bathurst Street. (Blue lines indicate catchment area.)

Program catchment area

map showing the cachement area, Lawrence to Steeles, Victoria Park to Bayview