Make a Referral

Upon receipt of referral information, Deena Ginsberg, Practice Director, will follow up with you immediately.

Referrals can be made by phone by calling us at 416-919-2500 or online by filling out the form below.

Client Information

*Client's Last Name:
*First Name:
Middle Name:
*Address:
*City:
*Postal Code:
*Telephone No. (Home):
Telephone No. (Cell):
*Date of Birth:
Gender: MaleFemale
*E-Mail Address:

Referral Source Information

*Referral Name:
*Referral Email:
Name of Agency:
*Telephone No:
Ext.:
Fax No.:
Is this Referral Source information the same as the Legal Representation? Yes

Insurance Information:

Name of Insurer:
Name of Adjuster:
Branch:
Claim Number
Date of Accident:
Telephone No:
Ext.:
Fax No.: