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Cardiac Care Services

Cardiac Test & Procedure Referrals

Referral Form	Fax #
Angioplasty Referral	519-663-3069
Cardiac Catheterization Referral Definitions	519-663-3069
Cardiac Surgery Referral	519-663-2948
ICD & CRT Referral	519-663-3782
Non-Invasive Diagnostic Test Requisition	519-663-3806 (UH) 519-685-8084 (VH)

Instructions

Procedure

Select the required referral form from the table. This will open a PDF version of the form in your browser.

Print the form and fill in the required information.

Please fax the completed form and all other necessary documentation to the fax number indicated for each form.

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Last Updated September 12, 2011 | © 2007, LHSC, London Ontario Canada