List of consent and referral forms used by physicians.
- Admission History and Physical
- Arthritis Clinic Patient Referral Form
- Breast Imaging - Needle Localization Core Biopsy Procedure
- Breast Health referral
- Cardiovascular & Pulmonary Rehabilitation Referral Form
- Consent for Disclosure of Personal Health Information
- Consent to Treatment, Operative Procedure or Investigation
- CT Requisition
- Domestic Abuse & Sexual Assault (DASA) Care Centre of York Region Patient Referral Form
- Diabetes Education Program Referral Form
- Diabetes Education Program Self-Referral Form
- Diagnostic Imaging Requisition
- EEG LAB Outpatient Requisition
- EMG Nerve Conduction Outpatient Requisition
- FIT positive colonoscopy referral
- Genetics Cancer Questionnaire
- Genetics Clinic family history questionnaire
- Genetics Clinic Referral
- Geriatric Outreach Services Referral
- High Risk Pregnancy Referral
- Home at Last Discharge Referral Form
- House of Hearing Referral Form
- Inpatient/Outpatient Thyroid Biospy Requisition
- Inpatient/Outpatient Vascular Inventional Radiology Requisition
- Mackenzie Health Referral to Emergency Department
- Medical Urgent Care Clinic
- Mental Health Adult Outpatient Referral Form
- MRI Requisition
- Neurosurgical Assessment Clinic Referral
- Ontario MOHLTC IG Request Form - Non-Neurology Fillable
- Ontario MOHLTC IG Request Form - Neurology Fillable
- Orthopedic Consultation or Joint Replacement Referral
- Pediatric Urgent Care Clinic Referral
- Preoperative Breast Localization Booking
- Pulmonary Function Requisition
- Routine Pregnancy Screening Referral
- Seniors Wellness Clinic Referral
- Shaw Clinic Child & Family Services (ages 6 to 18 years)
- TIA/Stroke/Neurology Clinic Community Referral
- Transfusion and Alternative Options/Release from Liability for Jehovah’s Witness
- Transfusion Medicine - Investigation of a Transfusion Reaction
Contact Us