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Mamaway Wiidokdaadwin Indigenous Interprofessional Primary Care Team fax number
(855) 941-2531
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Orillia Clinic - Mamaway Wiidokdaadwin
Used for: Referral submission and PHI disclosure consent for Mamaway Wiidokdaadwin Indigenous Interprofessional Primary Care Team; used for referrals to the clinic and related health documentation.
Fax destination details
- Department
- Orillia Clinic - Mamaway Wiidokdaadwin
- Purpose
- Referral submission and PHI disclosure consent for Mamaway Wiidokdaadwin Indigenous Interprofessional Primary Care Team; used for referrals to the clinic and related health documentation.
- Form
- Referral Consent Form — MWIIPCT Referral Consent Form
- Address
- Orillia Clinic, 210 Memorial Ave, Unit 112A&B, Orillia, ON L3V 7V1
- Voice phone
- 705-259-9520
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Fill patient details, consent to disclose health information to referred services (e.g., Indigenous Navigator, Traditional Healing, Mental Health & Addictions). Sign and submit via fax.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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