Cardiac Test & Procedure Referrals

Referral Form
Fax #
Angioplasty Referral
519-663-3069

Cardiac Catheterization Referral

519-663-3069
Cardiac Surgery Referral
519-663-2948

Cardiology eOrders & eReports Project - Implementation Communication April 2012

New update

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 9, 2016 | © 2007, LHSC, London Ontario Canada