Thanks for visiting our online referral form. There are a few options available to you; choose yours below: *

Great! What is your first and last name? *

Can you also share where you live? *

The name of your city or town would be great.
Great! When you fill out the online referral form, the information is sent directly to Provincial Sleep Group who will be in touch to book your appointment.

Let's start off by getting your full name: *

As it appears on your birth certificate or medical records.
Can you please tell us which province you reside in? *

If your province isn't listed, it's because we do not have any clinics located there. Please choose the province in which you would like to receive sleep testing.

Awesome! Just so we can recommend you to the nearest sleep clinic, can you provide your address? *

Please enter your: Street Address, City, Postal Code
Perfect! Could you please give us your date of birth? *

Please format as (MM/DD/YYYY)
Thanks, {{answer_JuCjlyCUjCon}}. What is your biological sex? *

Please provide us with your health care number. *

All information submitted is safe and secure!
What is the best phone number to reach you at? *

Just in case we need to get in touch with you sooner :)
What is the name of your family physician? *

Great! What is the name of your physician's clinic?

If you don't know the name, the location will do!
Can you please provide the phone number of the clinic? *

Done! It was that easy... We will be in touch with you shortly to set up an appointment!

If you have any additional questions or concerns, please type them here.
As mentioned, we will be in touch with you shortly to book your appointment for sleep testing. 

In the meantime, if you have any questions or concerns, please don't hesitate to reach out to us directly. Your submission will go to, but you can find the contact information for the clinic nearest you on our website.
Visit the Website
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When referring a patient to Provincial Sleep Group for sleep testing, please complete this form and fax or email to your local sleep clinic.

If you haven't referred to a Provincial Sleep Group clinic previously, visit to find the clinic nearest you.
Download the Printable Referral Form
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If you would like your physician to refer you to your local Provincial Sleep Group clinic, simply print and bring this form to your next appointment.

Once filled, you can either scan and email the PDF referral form to or directly to your local clinic. You can find the clinic nearest you at
Download a Printable Referral Form
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