Waterloo Wellington

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)
[email protected]

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 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: [email protected]

Phone: 1-888-883-3313 ext. 5443 

Mail:
Home and Community Care Support Services Waterloo Wellington 
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 [email protected].

For non-media-related enquiries about Home and Community Care Support Services and to serve you best, please visit the Contact Us page to access additional contact information.

Forms

TitleExcerptCategoriesLinkhf:doc_tagshf:doc_categorieshf:file_type
Community Nursing Clinics – Patient Handout

Information sheet for patients about Community Nursing Clinics located in Waterloo Wellington

Forms, Information Sheetwaterloo-wellingtonforms information-sheetpdf
Community Nursing Clinics – Patient Handout FR

Information sheet for patients about Community Nursing Clinics located in Waterloo Wellington ( French)

Forms, Information Sheetwaterloo-wellingtonforms information-sheetpdf
Coordinated Bed Access Program Transfer Request Form 551B

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

Formswaterloo-wellingtonformspdf
Home Care Services Request/Referral Form

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.

Formswaterloo-wellingtonformspdf
Hospice Palliative Care Services Request Form 031B

Completed by a Primary Care Physician

Formswaterloo-wellingtonformspdf
MAID (Medical Assistance in Dying) Fax Cover Sheet Form 068

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

Formswaterloo-wellingtonformspdf
MAID (Medical Assistance in Dying) Referral Form 031A

Completed by a Primary Care Physician

Formswaterloo-wellingtonformspdf
Medical Orders – Parenteral Therapy – 525

To order care relating to parenteral therapy

Formswaterloo-wellingtonformspdf
MHAN Referral Form

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)

Formswaterloo-wellingtonformspdf
Negative Pressure Wound Therapy NPWT Order Form 046

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

Formswaterloo-wellingtonformspdf
Palliative Care In-Patient Referral Form 279

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

Formswaterloo-wellingtonformspdf
Parenteral Nutrition (TPN) Referral Form 311A

Completed by a Primary Care Physician or Registered Dietician

Formswaterloo-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

Formswaterloo-wellingtonformspdf
Swallowing Questionnaire Form 015

Completed by Retirement Home staff when requesting a Swallowing Assessment

Formswaterloo-wellingtonformspdf
WW Rehab and Complex Continuing Care (CCC) Referral Form 550

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

Coordinated Bed Access, Formswaterloo-wellingtoncba formspdf