Physician Referral

If you are a physician and would like to refer your patient to Surgical Solutions Network for a private pay surgical procedure, please reach out to us through the website form below, or call our office phone at 1-888-888-4250 (press 5 on the phone tree to reach our referral team). If you reach out to us through our website, we will follow up within one business day.

Please send diagnostics to our office via fax. You can fax documents to fax number 905.366.4249 or [email protected].

Physicians: Please instruct the patient you are referring to fill out Surgical Solutions Network’s physician referral patient questionnaire prior to their surgical consultation. The questionnaire is only for patients who have been referred by their physician via the form below. Do not fill out the questionnaire if you are a self-referring patient.

Fields marked * are required

Referring Physician's Information

Patient's Information

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