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Ilan Nachim Ilan Nachim Ilan Nachim Addiction Medicine Doctor Bridges Medical Clinic Monitoring

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Registration and REFERRALS

There are three submission options for referrals and registration. Please choose the one that best suits your needs.
Please note that Bridges reserves the right to determine, on a case-by-case basis, whether available services are suitable for individual registrants.

For PatientVu submission form please contact us directly.

To submit a referral form online through this website click HERE

Online Registration / Referral Form

(Check your downloads folder if the document does not open automatically.)

To download a PDF form which can be printed and faxed back to us click HERE

Fillable Registration / Referral Form

To download a Word document (.doc) which can be e-mailed back to us, click HERE

(You may need to click 'Enable Editing' once you open the file.)

Blank Registration / Referral Form

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