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Referral Forms

Childbirth & Childrens Services

CHILDBIRTH & CHILDREN'S CENTRE ANTENATAL REFERRAL

CHILDBIRTH & CHILDREN'S CENTRE PHYSICIAN REFERRAL

NEONATAL FOLLOW UP CLINICS REFERRAL

PAEDIATRIC OUTPATIENT CLINIC REFERRAL

PAEDIATRIC DEVELOPMENT AND ASSESSMENT REFERRAL

PAEDIATRIC RESPIRATORY CLINIC REFERRAL

 

Diabetes 

DIABETES EDUCATION CENTER SELF REFERRAL

OUTPATIENT ADULT DIABETES EDUCATION REFERRAL

 

Diagnostic Imaging

CARDIO-RESPIRATORY ELECTRODIAGNOSTIC REFERRAL

CT MRI INTERVENTIONAL RADIOLOGY REQUISITION

DIAGNOSTIC IMAGING REFERRAL

EMG/NCS REFERRAL WITH NEUROLOGICAL CONSULTATION

REGISTERED NURSE PERFORMED SIGMOIDOSCOPY REFERRAL FORM

 

Emergency Department

EMERGENCY DEPT FRACTURE CLINIC REFERRAL

 

External

BRIDGE REFERRAL FORM

DWTC - HOSPITAL FAX REFERRAL (385B-13)

HOME AT LAST REFERRAL

SMOKERS HELPLINE REFERRAL

 

Mental Health

CHILD & ADOLESCENT SERVICES REFERRAL

CONSENT TO RELEASE PERSONAL HEALTH INFORMATION

CONSENT TO TREATMENT 

OUTPATIENT MENTAL HEALTH REFERRAL FORM

 

Oncology 

Markham Oncology Referral

BREAST HEALTH CENTER REFERRAL

COLORECTAL SCREENING PROGRAM REFERRAL

 

Orthopaedics - Total Joint Assessment Centre (TJAC)

TJAC REFERRAL – DR. HAIDER 

TJAC REFERRAL – DR MCMAHON

TJAC REFERRAL – DR. SANTONE

TJAC REFERRAL – DR. SHIRALI

 

Outpatient Clinics 

CHEST PAIN CLINIC REQUEST FOR CONSULTATION

CENTRE FOR RESPIRATORY HEALTH REFERRAL - COPD/ASTHMA

CENTRE FOR RESPIRATORY HEALTH REFERRAL - SLEEP DISORDERS LAB

FRACTURE CLINIC REFERRAL

OBSTETRICAL CLINIC REFERRAL

OSTEOPOROSIS CLINIC REFERRAL

PAIN & SYMPTOM MANAGEMENT REFERRAL

STROKE PREVENTION CLINIC REFERRAL

THERAPEUTIC PHLEBOTOMY REFERRAL

 

Rehabilitation 

OUTPATIENT REHAB REFERRAL

OUTPATIENT VIDEOFLUROSCOPIC SWALLOWING STUDY REFERRAL

 

 Telemedicine 

CLINICAL TELEMEDICINE CONSULT/REFERRAL

CLINICAL TELEMEDICINE CONSULT/REFERRAL FROM LONG TERM CARE HOME

TELEDERM REFERRAL