Professional Referral — TPM
For physicians, allied health professionals, and legal professionals referring a client.
Referring Professional Name
*
Clinic / Organization
*
Role
*
Please Select
Physician
Physiotherapist
Chiropractor
RMT
Occupational Therapist
Psychologist / Counsellor
Lawyer / Legal Professional
Other (Please specify)
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred contact method
Email
Phone
Patient / Client Full Name
*
First Name
Last Name
Patient / Client Email
*
example@example.com
Patient / Client Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Client Location / Timezone
Please Select
Pacific (UTC-8/-7)
Mountain
Central
Eastern
Atlantic
Newfoundland
International / Other (Please specify)
Reason for referral
Mobility / movement limitations
Chronic pain
Post-injury reconditioning
Neurological condition
Autoimmune / chronic illness
Performance training
Return-to-work conditioning
Other (specify)
Primary limitations / considerations
*
e.g., shoulder limitations, balance issues, fatigue, pain triggers, surgery history
Relevant diagnoses / precautions
Recommended training boundaries
e.g., avoid spinal flexion, no overhead press, limit impact, etc.)
Has this patient / client consented to this referral?
Yes
Not yet
Preferred referral urgency
Routine (1-2 weeks)
Priority (within 7 days)
Attachments
Browse Files
Drag and drop files here
Choose a file
e.g., clinic note, imaging summary, legal letter, etc.
Cancel
of
I confirm the client has provided consent for their contact information and referral details to be shared with Oasis Training & Education for the purposes of training coordination.
Submit Referral
Should be Empty: