Professional Referral

Please fill out the form below

All fields required*

Service Required

Method of Payment

Does the referrer prefer to speak with a staff member before we contact the client?

5 + 14 =

We can also accept professional referrals by fax: (902) 444-3104

If you complete an online referral and have not received a call from us within 48 hours (Mon-Fri), please email info@dynamichealthservices.ca and ensure we have your correct contact information. Occasionally forms are not received so do not hesitate to email. Thank you.