For clinicians
Refer a Patient
For physicians, nurse practitioners & referral coordinators
Aafiyat Specialist Network (ASN)
Rapid access to specialist and focused-practice care in Mississauga and Kitchener. Fax the referral, we book your patient directly, and the consult note is faxed back to you. Your patient stays with you for ongoing primary care.
Fax completed referrals to
Questions or urgent referrals: call / text / WhatsApp (289) 813-0786
One form for every service
The consolidated ASN referral form covers all services below. Just check what you need.
Download consolidated form (PDF)Service-specific referral forms
All forms are fillable PDFs you can complete on screen, save to your EMR, or print and fax.
Internal Medicine & Nephrology
CKD, proteinuria, resistant hypertension, electrolytes, complex medical review
Geriatrics
Geriatric assessment, memory, falls, polypharmacy. Home visits for eligible patients
Endocrinology
Diabetes, thyroid, osteoporosis, adrenal/pituitary, PCOS
Neurology
Headache, seizure, neuropathy, movement disorders, memory. Virtual (Fridays) or in person
Physiatry / Pain / MSK
MSK and spine pain, chronic pain, spasticity and therapeutic Botox, rehabilitation
Cardiology
Aafiyat Cardiology Clinic
Stable chest pain, palpitations, heart failure, murmurs, pre-op assessment
Skin Care
Acne, eczema, psoriasis, lesion and mole review, hair and nail concerns
Women’s Health
Dr. Afaf Alsebai & Dr. Sarwah Alawsi
IUD / Nexplanon, menopause, lactation support (IBCLC), cervical screening
Pediatrics
Dr. Ahmad Abdul Aziz & Dr. Zohra Ahsan
Newborn, development and behaviour, ADHD, asthma / eczema / allergy, growth
Newborn Circumcision (private pay)
Newborn and infant circumcision, pre-procedure consults
IV Iron Infusion (private pay / insurance)
Iron deficiency with or without anemia, oral iron intolerance, pregnancy / postpartum
Travel Medicine (private pay / insurance)
Pre-travel consults, travel vaccines, designated Yellow Fever Vaccination Centre
Weight Management & Nutrition
Aafiyat Lifestyle Medicine team
Medical weight management, prediabetes, fatty liver. Nutrition and exercise counselling (private pay / insurance)
How referral works
- Complete the consolidated or service-specific form.
- Attach recent labs, imaging and a medication list where relevant.
- Fax to (844) 614-2845. We contact your patient directly to book.
- The consult note is faxed back to your clinic after the visit.
OHIP-insured consultations require a physician or nurse practitioner referral. Services marked private pay are billed to the patient or their insurance. Coming soon: Gynecology and Psychiatry.
For emergencies, please direct patients to the nearest emergency department or call 911. Referrals contain personal health information; please send by fax only, not by email.