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Community Paramedic Program

About the Community Paramedic Program

Paramedic kneeling down assisting a person sitting in a chair

Who Are Our Clients?

What Services Do We Provide?

Community Paramedics Referral Form

Referrals are accepted from various community partners including Ontario Health, Primary Care Physicians, and hospital staff. The community paramedic will ensure the patient will benefit from the services of the program and contact them in order to complete an in home assessment. Email: Phone: 1-844-791-1182, Fax: 519-941-2486

Patient Information

Patient Name(Required)
Date of Birth(Required)
Patient Address(Required)

Primary Support Provider Information


Referrer's Information


Primary Care Information

Referral Criteria(Required)
Do you have any additional comments to share with the Community Paramedics?
Please type your name.

Information Collection

The information contained in this form is confidential. It contains personal health information that is subject to the provisions of the ‘Personal Health Information Protection Act, 2004’. This form and its contents should not be distributed, copied or disclosed to any unauthorized persons. If you have accessed this form in error, please contact the owner or sender immediately. All or part information from this referral form may be shared with other agencies to provide appropriate care. For questions please contact the Chief Paramedic at 519-941-9608 ext. 6001.
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