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Fill and fax a referral

Name: Vaughan Endoscopy Clinic
Address: 4610 Highway 7, Suite 200, Woodbridge, ON, L4L 4Y7, CA
Telephone: +1-905-856-2626
Price range: OHIP-covered

Type the details, print, and fax to 905-856-2602. Faster and more legible than filling the PDF by hand.

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This page has no submit button and no server behind it. What you type stays in your own browser until you print it, and is gone when you close the tab. That is deliberate: patient details belong on your fax line, not in our inbox.

Fill and fax a referral

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