Dr. N. Rishiraj, ATC, PhD
Director, High Performance & Rehabilitation Consultant
ACTIN Health & Rehabilitation Inc.
5767 Oak Street
Vancouver, BC
V6M 2V7
CANADA

(Tel) 604-244-3614
Email: actin@actinhealth.com

Complete Referral Form:

For your convenience, we have made a Referral Form available for download.
Due to liability reasons, (TO ENSURE PATIENT CONFIDENTIALLY AND TO FOLLOW THE PROVISIONS OF THE PROTECTION OF PRIVACY ACT) this form must be printed and mailed as a hard copy to the above address.

Follow these 5 easy steps to download and complete the form:

  1. Right click on the Referral Form link, and select "Save Target As..." (I.E.) or "Save Link As..." (Netscape).
  2. Save the form to a location on your hard drive.
  3. Once download is complete, double click it. When asked to choose between Enable/Disable Macros, choose Macros Enabled and fill in the form.
  4. Once you've completed the form, save it and print out a hard copy.
  5. Mail the printed form to ACTIN Health and Rehabilitation at the mailing address (above).

Download Referral Form (Word Doc.)

 

 

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