LHSC Medical Imaging Services
Below are the request forms for LHSC Medical Imaging services.
- View the Bone Mineral Density Scan Requisition PDF
- View the Computed Tomography (CT) requisition PDF
- View the Computed Tomography (CT) spine appropriateness checklist PDF
- View the Computed Tomography (CT) patient checklist PDF
- View the Magnetic Resonance Imaging (MRI) general requisition PDF
- View the Magnetic Resonance Imaging (MRI) knee appropriateness checklist PDF
- View the Magnetic Resonance Imaging (MRI) spine appropriateness checklist PDF
- View the Magnetic Resonance Imaging (MRI) patient checklist PDF
- View the Molecular Imaging and Theranostics (MIT) Nuclear Medicine Requisition PDF
- View the Ultrasound requisition PDF
- View the Victoria Hospital Orthopaedic Clinic Requisition PDF
- View the LHSC Peadiatric Ultrasound, Fluoroscopy and General X-ray Requisition PDF
- View the LHSC General Radiology Requisition PDF
Interventional Radiology
Requests for Interventional Radiology, please send a faxed request on your Clinical letterhead to:
- Department of Medical Imaging, University Hospital
Fax: 519-663-3034 - Department of Medical Imaging, Victoria Hospital
Fax: 519-667-6872
For other request forms, please visit the South West Primary Care Alliance webpage.
Referral guidelines and additional resources:
Canadian Association of Radiologists
- View the Referral Guidelines webpage for the Canadian Association of Radiologists.
Choosing Wisely Canada
Choosing Wisely Canada is a national organization promoting the reduction in unnecessary tests in and treatments. For information specific to Medical Imaging visit the Choosing Wisely Canada webpages for:
