Referral form

Physiotherapy referral

A physiotherapy referral tells a PT clinic what to treat, why, and who is paying. In much of Canada, community physiotherapy is private, insurer, WCB, or auto — not an open OHIP entitlement. Hospital outpatient and a few remaining publicly funded programs have their own PDFs. “PT please” with no body part and no payer is how the patient is turned away at reception.

CanadaPhysiotherapy clinics and hospital outpatient programs (form-specific)

What the PT needs on day one

Region, diagnosis or working diagnosis, red flags you already cleared (or did not), surgery date if any, and the functional goal. Weight-bearing status after fracture is not optional. Precautions after repair are not optional. Payer is not optional.

Use the clinic’s current referral. WCB, WSIB, ICBC, and SABS each have their own reporting after the patient is accepted. Your referral does not replace those reports. It gets the person in the door with a safe starting point.

OHIP is not a default payer

Do not write “bill OHIP” unless you know this patient is in a remaining publicly funded stream. If they have WSIB or a motor-vehicle claim, say so. If they are private, say private. Surprise billing is how complaints start.

Who completes it

The physician, nurse practitioner, or other professional the clinic requires as a referring source. In many provinces patients may self-refer to PT; your letter still matters for post-op, WCB, and medical precautions. Do not sign a referral for an injury you have not assessed.

How to complete the referral

Diagnosis and side. “Knee” is not enough.
Date of injury or surgery, and the procedure name if post-op.
Weight-bearing, ROM limits, bracing, DVT prophylaxis if relevant.
Red flags already negative (or the finding that is not): saddle anaesthesia, unexplained weight loss, fever, neuro deficit.
Goal: stairs, work, sport. “Get better” is not a goal.
Payer: private, insurer name, WCB/WSIB claim number, auto claim number.
Imaging already done so the PT does not re-order your MRI.

Worked example (fictional)

PT referral — post-op ACL, family practice

Fictional 22-year-old. Do not copy into a real PT referral.

Dx: left ACL reconstruction (hamstring autograft) 2026-08-10. WBAT in brace per op note. No DVT. Neurovascular intact.
Goal: protocol-based rehab toward return to rec soccer; not cleared for pivoting today.
Payer: private / student plan. Not WSIB. Not ICBC.
Precautions: follow surgeon’s week-0–6 protocol attached. I am the FP; surgeon is Dr. Chen.
Not an OT referral. Not a disability form.

Why clinics send patients back

No payer.
Post-op without the operation date or precautions.
WCB injury referred as “private cash” or the reverse.
Red-flag neurological symptoms with no comment.
Wrong discipline (asking PT for a cognitive home-safety assessment that is OT).

Draft the physiotherapy referral from the visit

In Scribeberry, open Forms, search for physiotherapy referral, or upload the clinic’s current PDF. Generate from the encounter and your notes, then review every field before you send. Scribeberry does not pre-map this form. You still review and sign. Scribeberry does not book physiotherapy.

Open Scribeberry

Frequently asked questions

Does the patient need a referral to see a physiotherapist?

In many provinces they can self-refer. Insurers, WCB, post-op programs, and some hospitals still want a physician or NP letter. Complete the form the clinic or payer asked for.

Is this the same as a WSIB or WorkSafeBC PT report?

No. Those boards have their own physiotherapy reports after care starts. This page is the referral in. Do not use a Form 8 as a PT referral.

PT or OT?

Musculoskeletal rehab, gait, and post-op protocols are usually PT. Cognitive, ADL, and home-safety equipment are often OT. If you need both, say both.

Does Scribeberry send the referral to the clinic?

No. Scribeberry helps you complete the PDF. You or the patient send it. Keep a copy in the chart.

Forms