Instructions
- 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
- View the Angioplasty Referral Form PDF
- Fax: 519-663-3069
Cardiac Catheterization Referral
- View the Cardiac Catheterization Referral Form PDF
- Fax: 519-663-3069
Cardiac Surgery Referral
- View the Cardiac Surgery Referral Form PDF
- Fax: 519-663-2948
ICD & CRT Referral
- View the ICD & CRT Referral Form PDF
- Fax: 519-663-3782
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
