Referral Form*

The form below (print/PDF version here) can be submitted via fax (204-221-8847), website, or mailed in confidence to Apex Therapy Services. Should you have any further questions regarding services, costs, etc. of Apex Therapy Services, please contact the owner and Occupational Therapist, Mr. Russel Dyck O.T.Reg.(MB) at 204-415-3973.

*All supplied information is encrypted prior to transmission.

Client information

Service(s) requested: (Please check all that apply)

Apex Therapy Services