Urology

All referral forms on this website are also available as eForms for OSCAR, Avaros, Indivicare, and ACCURO EMRs. You can download some of the premade forms here from WorldEMR or fill the contact form below for any other eForms that are not listed for your EMR.

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Clinics

ClinicServicesLocationFormContactInformation
Prostate Diagnostic Assessment Program1. Prostate cancerSt. Joseph’s Hospital
Room B4-602
268 Grosvenor Street
London, Ontario N6A 4V2
Prostate DAP Referral FormPhone: 519-646-6000 ext 65622
Fax: 519-646-6217
Fax Referral
Website
Renal Colic New Patient Referral Form1. Ureteral Colic SJHC LHSCRenal Colic Referral FormFax Referral
LHSC ER Urology Clinic (VH Only)1. UrologyLHSC – Victoria HospitalVH Outpatient ReferralPhone: 519-685-8500 x 58450
Fax: To Physicians office
Fax consult
MD office will call patient

London Physicians

London PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Dave, Sumit1. Urology
2. Pediatric Urology
LHSC – Victoria HospitalGeneric FormPhone: 519-685-8439
Fax: 519-667-6581
Fax consult
Dr. Izawa, Jonathan1. Urology
2. Uro-oncology Surgery
*NOT: Pediatrics, sexual dysfunction, female incontinence, infertility*
LHSC – Victoria HospitalGeneric FormPhone: 519-685-8550
Fax: 519-685-8455
Fax consult
Dr. Power, Nicholas1. Urology
2. Kidney Stones
3. Uro-oncology Surgery
LHSC – Victoria HospitalGeneric FormPhone: 519-667-6787
Fax: 519-685-8455
Fax consult
Dr. Luke, Patrick1. UrologyLHSC – University HospitalGeneric FormPhone: 519-663-3180
Fax: 519-663-3858
Fax consult
Dr. Sener, Alp1. UrologyLHSC – University HospitalGeneric FormPhone: 519-663-3352
Fax: 519-663-3858
Fax consult
Dr. Denstedt, John1. Urology
2. Kidney Stones
St. Joseph’s Healthcare CentreGeneric FormPhone: 519-646-6036
Fax: 519-646-6037
Fax consult
Dr. Pautler, Stephen1. Uro-oncology Surgery (only)St. Joseph’s Healthcare CentreGeneric FormPhone: 519-646-6384
Fax: 519-646-6037
Fax consult
Dr. Razvi, Hassan1. Urology
2. Kidney Stones (Will see Peds Kidney Stones)
St. Joseph’s Healthcare CentreGeneric FormPhone: 519-646-6259
Fax: 519-646-6037
Fax consult
Dr. Welk, Blayne1. Urology
2. Incontinence
St. Joseph’s Healthcare CentreGeneric FormPhone: 519-646-6367
Fax: 519-646-6037
Fax consult

Stratford Physicians

Stratford PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Bukala, Bernard1.Urology378 Huron St, Suite A
Stratford, ON
N5A 5T5
Generic FormPhone: 519-272-0064
Fax: 519-272-0447
Fax consult

St. Thomas Physicians

St. Thomas PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Cheng, Michael1. Urology202 Elm St
St Thomas, ON
N5R 1J3
Generic FormPhone: 519-633-4034
Fax: 519-633-3412
Fax consult

Strathroy Physicians

Strathroy PhysiciansSubspecialty / InterestLocationFormContactInformation

Woodstock Physicians

Woodstock PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Kamal, Fadi1.Urology333 Athlone Ave, Suite 105
Woodstock, ON
N4V 0B8
Generic FormPhone: 519-533-6964
Fax: 519-533-6965
Fax consult
Dr. Violette, Phillppe1.Urology
2. Kidney Stones
3. Uro-oncology Surgery
4. Circumcision
333 Athlone Ave, Suite 105
Woodstock, ON
N4V 0B8
Generic FormPhone: 519-533-6966
Fax: 519-533-6967
Fax consult

Pediatric Physicians

Pediatric PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Dave, Sumit1. Pediatric UrologyLHSC – Victoria HospitalGeneric FormPhone: 519-685-8439
Fax: 519-685-8455
Fax consult

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