Physician Referral Form

Please note that all referrals must come from a physician’s office. The forms linked below are intended for physician use only:

• Personalized Medicine Clinic (Dr. Richard Kim) Referral Form for GI patients
• Personalized Medicine Referral Form for Oncology Patients
• Personalized Medicine Clinic General Referral Form

Personalized Medicine Clinic
London Health Sciences Centre, University Hospital
339 Windermere Road London, ON, N6A 5A5

Telephone: 519-685-8500 ext. 34340
Fax: 519-663-3090
Email: PersonalizedMeds@lhsc.on.ca