Refer a client, employee or student
Thank you for choosing to refer an individual to Vision Loss Rehabilitation Canada for support with their vision loss. We encourage you to complete all fields on this form so that we can build the best possible rehabilitation plan for the individual; however, only those fields marked with an asterisk (*) are required.
Please email us at firstname.lastname@example.org if you have a problem submitting this form.
If you prefer, you can download and complete an accessible version of the Community Referral Form (PDF) and send it by fax to 416-480-7700.