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
For more information about referring to the Stronach Regional Cancer Centre at Southlake, click here.
Diagnostic Assessment Unit
Colon Cancer Check Referral Form (SL 1367A)
Physicians use this form to refer patients to the Diagnostic Assessment Unit for colonoscopy in cases where there has been a positive FOBT or first-degree relative with history of colon cancer.
(Mammography, Bone Density, X-Ray, Breast Ultrasound)
- Lung Volumes by Body Plethysmography