• << Return to Order Brochures Page

  • Brochure Order Form - Specialized Geriatric Services

  • The brochure comes with an attached referral form, and is required to make referrals through the Easy Coordinated Access process to Waterloo Wellington Specialized Geriatric Services.

    Health provider professionals (physicians, nurses, case managers, physiotherapists etc...) in the Waterloo Wellington area (WWLHIN boundaries) may order brochures. There is no charge.

    Order brochures by filling out the form below. 

  • Order Information

  • You should order a supply that equivalent to 6 months of referrals.


  • Note: These brochures are designed to facilitate a direct referral process only and NOT meant for public distribution (i.e. do not order copies to place on a public "brochure wall").

  • Contact Information

  •  -
  • Mailing Information

    This is the address to which brochures will be mailed.
  • You will be sent a confirmation email after completion of this form.

  •                                         Cancel

  • Should be Empty: