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 Care 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

palliative care map