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Your partners in health care

For Patients

If you would like to make a self-referral to Fountain Health, please complete the following form. A member of our clinical team will contact you to schedule an appointment.

NOTE: To improve efficiency and quality, please provide as much information as possible to help us minimize duplication and avoid additional appointments. The information you share with us will be kept confidential. When we receive a referral, we may contact your GP and other healthcare providers for past medical records to ensure we are the most suitable service for you. You must be 18 or older to refer yourself. Our privacy policy can be viewed here.


Thank you for your referral.

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