Requisition and Referral Forms
Below is an index of referral and requisition forms to refer patients to Southlake services. These forms must be completed by a healthcare professional, i.e. doctor.
If you feel that you should be referred for one of these services please speak with your doctor.
Stronach Regional Cancer Centre
Cancer Centre Referral Form (out-patient)
For more information about referring to the Stronach Regional Cancer Centre at Southlake, click here.
Flexiable Sigmoidoscopy Referral Form (SL1760)
Outpatient Psychosocial Oncology & Palliative Care Referral Form