CORE Medical Centre Referral Form

Please download, complete and email or fax the form below if your client or employee requires one or more of the following assessments:

• Independent Medical Exam (IME)
• Functional Capacity Evaluation (FCE)
• Cost of Future Care (CFC)

Who should use this form?

This form is for referrals from:

• Lawyers
• Insurance companies
• Employers
• Unions

Fax to 604-525-8124
Email to manager@coremedicalcentre.ca

CORE Referral Form (WORD)

CORE Referral Form (PDF)