Cardiac Test & Procedure Referrals


  • 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.

Angioplasty Referral

Cardiac Catheterization Referral 

Cardiac Surgery Referral 

ICD & CRT Referral 

Non-Invasive Diagnostic Test Requisition

View the Non-Invasive Diagnostic Test Requisition PDF

  • University Hospital: Fax: 519-663-3806 
  • Victoria Hospital: Fax: 519-685-8084