Referral forms

Cancer care (Oncology)

Breast Health Centre referral

Markham oncology referral

Smoker's helpline referral

Stroke prevention clinic referral

Pain and symptom management referral

 

Care transitions

Community Medicine Clinic hospital to home program referral

Home at Last referral

 

The Stollery Family Centre for Childbirth & Children's Services

Antenatal Referral - Childbirth and Children's Services (for pregnancy and birth referrals)

Childbirth and Children's Services - Physician referral

Neonatal follow-up clinic referral

Obstetrical clinic referral (for early pregnancy assessments)

Paediatric outpatient clinic referral (PAC, newborn, endocrinology, and diabetes)

Paediatric lifestyle clinic and nutrition services 

Paediatric respiratory clinic referral

 

Diagnostic services

2012 CAR Diagnostic Imaging referral guidelines

CT/MRI Interventional Radiology requisition

Diagnostic Imaging referral

DI referral guidelines

EMG/NCS referral with neurological consultation

Cardio-respiratory electrodiagnostic referral

MRI Knee appropriateness checklist

MRI Spine appropriateness checklist

OBSP Ontario Breast Screening Program referral

 

Laboratory services

Therapeutic phlebotomy referral

 

Mental health

Bridge program referral

Outpatient mental health referral

Women's wellness services referral

 

Outpatient clinics

COPD/Asthma referral - Centre for respiratory health

Diabetes education centre self referral (adult patients)

Emergency Department Fracture Clinic referral

Falls prevention class referral

Fracture Clinic referral

Osteoporosis clinic referral

Outpatient adult diabetes education referral

Outpatient rehab referral

Outpatient videofluroscopic swallowing study referral

Seniors' health clinic referral 

Sleep disorders lab referral

Clinical telemedicine consult/referral

Clinical telemedicine consult/referral from long-term care home

RN flexible sigmoidoscopy referral form

Telederm referral

 

OJAC Referrals

Orthopaedic Consultation Knee and Hip Arthritis Management - Dr. Haider

Orthopaedic Consultation Knee and Hip Arthritis Management - Dr. Koo

Orthopaedic Consultation Knee and Hip Arthritis Management - Dr. McMahon

Orthopaedic Consultation Knee and Hip Arthritis Management - Dr. Shirali

Orthopaedic Consultation Knee and Hip Arthritis Management - Dr. Watts

Orthopaedic Consultation Knee and Hip Arthritis Management - General