How to Make a Referral

At Victoria Hospital:

Referrals from LHSC Physicians/Delegates and or Physicians with Admitting Privileges to LHSC ONLY are accepted for:  

  • Standard Hearing Assessments (Audiogram) 

Referrals are accepted from all LHSC and community Physicians for:  

  • Auditory Brainstem Evoked Response Assessments 
    • Hearing Threshold Protocol (Sedated ABR for children) 

Referrals from LHSC and community Otolaryngologists or Neurologists ONLY are accepted for:  

  • Auditory Brainstem Evoked Response Assessments 
    • Neurological Protocol    

Referrals can be made through order entry in the Electronic Patient Record or by faxing VH Audiology at 519-685-8077.

When referring a patient – Physicians are to indicate their referring Service/Program.

Referral Form for Victoria Hospital Audiology

Note: In order to accept a referral for Sedated ABR Assessment - it is essential that evidence of following are included:

  1. Multiple behavioural hearing assessments
    1. Recommended to be completed by a CASLPO Registered Audiologist; for resources in your area, please see the CASLPO website 
    2. If behavioural thresholds cannot be obtained please state the reasons why
  2. Infant Hearing Program (IHP) status of patient  
    1. To obtain information regarding the patient’s hearing screening at birth and/or current IHP status contact the IHP location in your area, please see the Infant Hearing Program.

 

At University Hospital:

Referrals from LHSC and community Otolaryngologists or Neurologists ONLY are accepted for:  

  • Cervical Vestibular Evoked Myogenic Potentials (VEMP)
  • Video-Nystagmography (VNG)
  • Neurological Auditory Brainstem Evoked Response (ABR)
  • Electrocochleography (ECOG)

Referrals can be made by faxing UH Audiology at 519-663-3916.

Referral Form for University Hospital Audiology

Make a referral to the Cochlear Implant Program here.