SECURE COMMUNITY REFERRAL

Submit a Community Referral

Use this secure referral form to connect someone with Bloom Path for personalized incontinence care, product guidance, ODSP and funding navigation, and more.

Referral information is used for support purposes only—not promotional marketing.

1. Referring Organization

2. Individual or Family Being Referred

3. What Can Bloom Path Help With?

4. Tell Us About the Referral

You do not need to know exactly what products or services are needed. A Bloom Path Care Specialist can help determine the appropriate next steps.

Your privacy matters to us. Information submitted through this referral form is used only to review the referral, contact the individual or their authorized representative, and provide the requested Bloom Path support. Bloom Path does not sell referral information or use referral contact information for promotional offers or marketing communications. Please only provide information necessary for Bloom Path to assist with the referral.

Supporting Documents

Supporting documents can be sent separately by fax.

+1 (905) 248-3715

Please include the referring organization's name and contact information so Bloom Path can match the documents to the referral.