Palliative and Supportive Care Referral Forms

Inpatient consult

To access a palliative and supportive 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.

Palliative Care Clinic (formerly Pain & Symptom Management Clinic)

For patients with cancer-related advanced illness. To access a Palliative Care Clinic consult, fax the Palliative Care Clinic Referral Form to 416-756-6833.

Supportive Care Clinic

For patients with non-cancer-related advanced illness. To access a Supportive Care Clinic consult, fax this Supportive Care Clinic Referral Form to 416-756-6702.

Outreach Programs (Freeman Outreach & The Edwin S.H. Leong Geriatric Supportive Care Outreach Program)

For an outreach or “home-based” palliative and supportive 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, and the Edwin S.H. Leong Geriatric Supportive Care Outreach Program offers home visits for adults living with advanced non-cancer illness.

Our outreach programs operate 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

palliative care map