Requests for Imaging

Requests for CT scan, MRI, Nuclear Medicine and Ultrasound services please see the South West Digital Coalition’s Forms Repository

• CT requisition
• CT spine appropriateness checklist
• MRI general requisition
• MRI knee appropriateness checklist
• MRI spine appropriateness checklist
• Nuclear Medicine Requisition
• Ultrasound requisition
• VH Ortho Clinic Requisition
• LHSC Peads Requisition 
• LHSC General Radiology Requisition

General Requests (e.g.  X-ray)

• Require a X-ray requisition form

Requests for Interventional Radiology, please send faxed request on your letterhead to

• UH: Fax (519) 663 - 3034
• VH: Fax (519) 667 - 6872

Referral Guidelines

• Choosing Wisely Canada for Medical Radiation Technology
  by Canadian Association of Medical Radiation Technologists
• Choosing Wisely Canada for Nuclear Medicine
  by Canadian Association of Nuclear Medicine