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Diagnostic Assessment Forms
 

These forms are meant for healthcare providers to download and use to refer patients to Diagnostic Assessment Programs across the province. Please direct all enquiries and completed forms directly to the appropriate Diagnostic Assessment Program.

Region / LHIN Facility Referral Form
Erie St. Clair Windsor Regional Hospital
Colorectal, Lung, Prostate
South West
Grey Bruce Health Services
Thoracic, Prostate
South West
London Health Sciences
Thoracic, Colorectal, Hepato/Pancreatic/Biliary-Rectal (HPB-R)
South West
St. Joseph's Health Care London
Prostate
Waterloo Wellington Grand River Hospital
Thoracic
Waterloo Wellington
Waterloo Wellington Regional Colonoscopy Network
Colonoscopy
Waterloo Wellington
Waterloo Wellington (Nurse Navigator)
GI, Breast, Prostate
Hamilton Niagara Haldimand Brant
St. Joseph's Hamilton, Niagara Health System and Brant Community Health System General
Lung, Esophageal
Mississauga Halton / Central West
Trillium Health Partners, Mississauga Halton/Central West Regional Cancer Program Breast, Hepato-Pancreatic-Biliary, Thoracic, Rectal
Mississauga Halton / Central West
William Osler Health System, Mississauga Halton / Central West Regional Cancer Program Thoracic
Toronto Central (North)
Sunnybrook Health Sciences Centre
Colorectal, Lung
Toronto Central (North)
Michael Garron Hospital
Lung, Thyroid, Breast, Colorectal
Toronto Central (South) Mount Sinai Hospital Colorectal
Toronto Central (South) University Health Network Breast, Colorectal, Thoracic
Central
North York General Hospital
Prostate
Central
Southlake
Breast, Lung, Colorectal, Prostate
Central East
Lakeridge Health, Peterborough Regional Health Centre and Rouge Valley Centenary
Thoracic
Central East
Lakeridge Health
Prostate, Colorectal
South East
Kingston General Hospital
Lung
South East Hotel Dieu, Kingston Colorectal
Champlain The Ottawa Hospital
Cancer Assessment Clinic and Ottawa Regional Women's Breast Health Centre
Breast, Lung, Colorectal, Prostate
North Simcoe Muskoka Royal Victoria Hospital
SOC, Thoracic, or Rectal
North East
Health Sciences North
Colonoscopy
North East North East Cancer Centre Lung
North East Sault Area Hospital
(Algoma only)
Lung
North West Thunder Bay Regional Health Sciences Centre Lung, Colonoscopy
Last modified: Fri, Jul 21, 2017
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