Waterloo Wellington area

Information and Referral

310-2222

(No area code required)

Toll-free: 1-888-883-3313
TTY:711 (caller to ask for 1-888-883-3313)
waterloowellington@ontariohealthathome.ca

IMPORTANT: DO NOT send any personal health information.  This email is not for patient feedback or referrals. Please call us directly at the numbers listed above. We aim to respond within 72 hours, however, this email account is not checked on weekends or statutory holidays.

Visit Waterloo Wellington Healthline

Waterloo Wellington Area Office Locations

  • Waterloo(Corporate Office)
    141 Weber Street South, 
    Waterloo, ON, N2J 2A9
    Fax:  (Waterloo Region) 519-883-5555
  • Cambridge
    73 Water Street North,
    Suite 501,
    Cambridge, ON,   N1R 7L6
    Fax:  (Cambridge – North Dumfries)  519-623-5068
  • Guelph
    1 Stone Road West, 
    Guelph, ON, N1G 4Y2
    Fax:  (Guelph | Wellington County) 519-823-8682

Compliments and Concerns?

Please share your feedback with your care coordinator. You may also share compliments or concerns in the following ways:

Email: patient.relations.ww@ontariohealthathome.ca

Phone: 1-888-883-3313 ext. 5443 

Mail: Ontario Health atHome
Compliments and Concerns
Attn: Manager, Patient Relations
141 Weber Street South  
Waterloo, ON 
N2J 2A9 

Newsroom and Media Relations

Visit our newsroom for more information on news and events. 

For all media-related enquiries, please contact media@ontariohealthathome.ca.

For non-media-related enquiries, please visit the Contact Us page to access additional contact information.

Forms

TitleSummaryRegionLast ModifiedCategoryFile TypeFile SizeLinkhf:doc_tagshf:doc_categorieshf:file_type
Coordinated Bed Access Program Transfer Request Form 551B – EN

Completed by a Coordinated Bed Access Coordinator (HCCSS staff) for transfers in the rehab bed program

July 4, 2024pdf284 KBwaterloo-wellingtonformspdf
Form 552 CBA Bed Vacancy Notification

Form 552, Notification of Rehabilitative Care, Palliative Care, Transitional Care or Residential Hospice Bed Vacancy

June 11, 2024pdf142 KBwaterloo-wellingtonformspdf
Formulaire de demande pour la divulgation de renseignements personnels

Formulaire de demande pour la divulgation de renseignements personnels. En vertu de la Loi de 2004 sur la protection des renseignements personnels sur la santé Veuillez

, , , , , , , , , , , , , , July 8, 2024pdf2 MBcentral central-east central-west champlain erie-st-clair global hamilton-niagara-haldimand-brant mississauga-halton north-east north-simcoe-muskoka north-west south-east south-west toronto-central waterloo-wellingtonformspdf
Hospice Palliative Care Services Request Form 031B

Completed by a Primary Care Physician

July 4, 2024pdf1 MBwaterloo-wellingtonformspdf
MAID (Medical Assistance in Dying) Fax Cover Sheet Form 068

Fax cover sheet that can be used to accompany MAID referral document

November 1, 2023pdf194 KBwaterloo-wellingtonformspdf
MAID (Medical Assistance in Dying) Referral Form 031A

Completed by a Primary Care Physician

November 1, 2023pdf151 KBwaterloo-wellingtonformspdf
Medical Orders – Parenteral Therapy – 525 – EN

To order care relating to parenteral therapy

July 4, 2024pdf296 KBwaterloo-wellingtonformspdf
MHAN Referral Form – EN

Mental Health and Addictions Nursing Program Referral Form – Completed by a School Social Worker (SW) or Child/Youth Worker (CYW), Primary Care Physician, Psychiatrist, CAIP (GRH staff in the inpatient mental health program)

July 4, 2024pdf287 KBwaterloo-wellingtonformspdf
Negative Pressure Wound Therapy NPWT Order Form 046 – EN

Can be completed by a Primary Care Physician, Nurse Practitioner, NSWOC(Nurse specializing in wound, ostomy and continence care), or CNS (clinical Nurse specialist)

July 4, 2024pdf813 KBwaterloo-wellingtonformspdf
Negative Pressure Wound Therapy Referral Form

Note: NPWT will continue to be assessed in the community, and settings may be reviewed based on exudate and patient tolerance. Continuation of NPWT is dependent on wound healing goals being met. Maximum treatment time for NPWT is 8 weeks.

July 16, 2024pdf83 KBwaterloo-wellingtonformspdf
Palliative Care In-Patient Referral Form 279 – EN

Completed by a community or hospital care coordinator (HCCSS staff) along with the patient/family for EOL(end of life) care

July 4, 2024pdf2 MBwaterloo-wellingtonformspdf
Parenteral Nutrition (TPN) Referral Form 311A – EN

Completed by a Primary Care Physician or Registered Dietician

July 4, 2024pdf854 KBwaterloo-wellingtonformspdf
Request for Release of Personal Health Information

Request for Release of Personal Health Information under the Personal Health Information Protection Act, 2004

, , , , , , , , , , , , , , July 8, 2024pdf2 MBcentral central-east central-west champlain erie-st-clair global hamilton-niagara-haldimand-brant mississauga-halton north-east north-simcoe-muskoka north-west south-east south-west toronto-central waterloo-wellingtonformspdf
Request for Services

Completed by Primary care Physician to request Home Care services. Patient/Families may also print this referral form to bring to an appointment for completion.

June 28, 2024pdf145 KBwaterloo-wellingtonformspdf
Retirement Home Service Information Form 150

Completed by Retirement Home(RH) or HCCSS staff to outline services that a patient is currently receiving or may require if moving to a Retirement Home setting

July 4, 2024pdf483 KBwaterloo-wellingtonformspdf
Swallowing Questionnaire Form 015 – EN

Completed by Retirement Home staff when requesting a Swallowing Assessment

July 4, 2024pdf465 KBwaterloo-wellingtonformspdf
WW Rehab and Complex Continuing Care (CCC) Referral Form 550 – EN

Application for HCCSS staff to be completed for a patient moving from Acute Care to a Rehab bed in the WW region.

July 4, 2024, pdf310 KBwaterloo-wellingtoncba formspdf