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Get Baycrest Memory Clinic Referral Form

Cuses on neurodegenerative diseases. We do not accept patients for assessment or management of the following disorders: Developmental disorders (e.g., ADHD, learning disorder) Traumatic brain injury Chronic fatigue syndrome Alcohol or substance dependence or abuse Occupational and environmental exposures Multiple sclerosis Seizures Toxic encephalopathy Name of Client Male Date of Birth Marital Status Street Address Apt. # Province Health Card # Postal C.

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