Submit Your Referral Form
Please select a referral form from the list below. You can choose between the Online version (submitted electronically) or PDF (to be printed and forwarded to Banyan Work Health Solutions’ Administrative Centre by email, at firstname.lastname@example.org, or via fax to 416-588-9235 or toll free fax at 1-877-263-0123).
|Banyan Referral Form – Employer Notification Form|
|Banyan Referral Form – Insurer Services Rehabilitation Case Management|
|Banyan Referral Form – Specialty Services|
|Banyan Referral Form – PillCheck™|