Waterloo Wellington

Information and Referral


(No area code required)

Toll-free: 1-888-883-3313
TTY:711 (caller to ask for 1-888-883-3313)

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: patient.relations.ww@hccontario.ca

Phone: 1-888-883-3313 ext. 5443 

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 HCCSSmedia@hccontario.ca.

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.


TitleSummaryRegionLast ModifiedCategoryFile TypeFile SizeLinkhf:doc_tagshf:doc_categorieshf:file_type
Community Nursing Clinics – Patient Handout

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

May 4, 2023, pdf341 KBwaterloo-wellingtonforms information-sheetpdf
Community Nursing Clinics – Patient Handout FR

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

May 4, 2023, pdf327 KBwaterloo-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

November 1, 2023pdf233 KBwaterloo-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.

November 1, 2023pdf1 MBwaterloo-wellingtonformspdf
Hospice Palliative Care Services Request Form 031B

Completed by a Primary Care Physician

November 1, 2023pdf1 MBwaterloo-wellingtonformspdf
MAID (Medical Assistance in Dying) Fax Cover Sheet Form 068

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

November 1, 2023pdf194 KBwaterloo-wellingtonformspdf
MAID (Medical Assistance in Dying) Referral Form 031A

Completed by a Primary Care Physician

November 1, 2023pdf151 KBwaterloo-wellingtonformspdf
Medical Orders – Parenteral Therapy – 525

To order care relating to parenteral therapy

November 1, 2023pdf131 KBwaterloo-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)

November 1, 2023pdf229 KBwaterloo-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)

November 1, 2023pdf785 KBwaterloo-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

November 1, 2023pdf1 MBwaterloo-wellingtonformspdf
Parenteral Nutrition (TPN) Referral Form 311A

Completed by a Primary Care Physician or Registered Dietician

November 1, 2023pdf855 KBwaterloo-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

November 1, 2023pdf308 KBwaterloo-wellingtonformspdf
Swallowing Questionnaire Form 015

Completed by Retirement Home staff when requesting a Swallowing Assessment

November 1, 2023pdf403 KBwaterloo-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.

November 1, 2023, pdf269 KBwaterloo-wellingtoncba formspdf