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.
Table of Contents
London Physicians
London Physicians | Services | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Moore, Corey | 1. Otolaryngology 2. Facial Skin Cancer and Reconstruction | St. Joseph’s Healthcare Centre | Generic Form | Phone: 519-646-6383 Fax: 519-646-6173 | Fax consult Website |
Dr. Rotenberg, Brian | 1. Otolaryngology 2. Nasal and Sinus Surgery 3. Endoscopic Skull Base Surgery 4. Snoring and Sleep Apnea Surgery | St. Joseph’s Healthcare Centre | Generic Form | Phone: 519-646-6320 Fax: 519-646-6173 | Fax consult |
Dr. Roth, Kathryn | 1. Otolaryngology 2. Head and Neck Oncology 3. Melanoma and Skin Cancer & Reconstruction | St. Joseph’s Healthcare Centre | Generic Form | Phone: 519-646-6124 Fax: 519-646-6173 | Fax consult Speaks French |
Dr. Sowerby, Leigh | 1. Otolaryngology 2. Nasal and Sinus Concerns 3. Endoscopic Skull Base Surgery 4. Septorhinoplasty | St. Joseph’s Healthcare Centre | Generic Form | Phone: 519-646-6143 Fax: 519-646-6173 | Fax consult |
Dr. Agrawal, Sumit | 1. Otolaryngology 2. Neurotology 3. Skull Base Surgery 4. Hearing 5. Facial Nerve Disorders 6. Vestibular Disorders | LHSC – University Hospital | Generic Form | Phone: 519-663-3568 Fax: 519-663-3916 | Fax consult |
Dr. Parnes, Lorne | 1. Otolaryngology 2. Otology/Neurotology 3. Hearing & Vestibular Disorders 4. Lateral Skull Base Surgery 5. Facial Nerve Disorders | LHSC – University Hospital | Generic Form | Phone: 519-663-3604 Fax: 519-663-3916 | Fax consult |
Dr. Fung, Kevin | 1. Otolaryngology 2. Laryngology 3. Vocal Cord Surgery *NOT Peds or ears* | LHSC – Victoria Hospital | Generic Form | Phone: 519-685-8599 Fax: 519-685-8567 | Fax consult |
Dr. MacNeil, Danielle | 1. Otolaryngology 2. Thyroid Surgery 3. Head and Neck Oncology | LHSC – Victoria Hospital | Generic Form | Phone: 519-685-8767 Fax: 519-685-8567 | Fax consult |
Dr. Nichols, Anthony | 1. Otolaryngology 2. Thyroid Surgery 3. Head and Neck Oncology 4. Anterior Skull Base Surgery | LHSC – Victoria Hospital | Generic Form | Phone: 519-685-8804 Fax: 519-685-8567 | Fax consult |
Dr. Yoo, John | 1. Otolaryngology 2. Head and Neck Oncology | LHSC – Victoria Hospital | Generic Form | Phone: 519-685-8457 Fax: 519-685-8567 | Fax consult Speaks Korean |
St. Thomas, Strathroy, Stratford & Woodstock Physicians
St. Thomas, Strathroy, Stratford & Woodstock Physicians | Services | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Hanson, Wayne | 1. Otolaryngology | 230 First Ave, Suite 205 St. Thomas, ON N5R 4P5 | Generic Form | Phone: 519-631-6391 Fax: 519-631-6393 | Fax consult |
Dr. Raymond, Marc | 1. Otolaryngology 2. Facial Plastic Surgery | Strathroy Middlesex General Hospital | Generic Form | Phone: 519-245-3888 Fax: 519-245-3889 | Fax consult |
Dr. Chueng Chen Chuan, Kristelle | 1. Otolaryngology | 150 Huron St, Ground Fl Stratford, ON N5A 5S8 | Generic Form | Phone: 519-305-3311 Fax: 226-633-5800 | Fax consult |
Dr. Hughes, Brian | 1. Otolaryngology | 289 Huron St Stratford, ON N5A 5T3 | Generic Form | Phone: 519-273-7400 Fax: 519-273-2899 | Fax consult |
Dr. Jeremic, Goran | 1. Otolaryngology | Woodstock Hospital | Generic Form | Phone: 519-537-7509 Fax: 519-537-8516 | Fax consult |
Pediatric Physicians
Pediatric Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Husein, Murad | 1. Pediatric Otolaryngology 2. Laryngology & Vocal Cord Surgery 3. Maxillofacial Deformity Surgery | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8184 Fax: 519-685-8185 | Fax consult |
Dr. Paradis, Josee | 1. Pediatric Otolaryngology 2. Pediatric Sleep Disordered Breathing 3. Congenital Hearing Loss | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8794 Fax: 519-685-8567 | Fax consult Speaks French |
Dr. Strychowsky, Julie | 1. Pediatric Otolaryngology 2. Aerodigestive Disorders 3. Voice Disorders 4. Otology 5. Surgical Sialorrhea Management | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8242 Fax: 519-685-8185 | Fax consult |
Dr. Graham, Elise | 1. Pediatric Otolaryngology 2. Vocal fold paralysis/laryngeal reinnervation 3. Aerodigestive disorders 4. Dysphagia 5. Hearing loss | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8242 Fax: 519-685-8185 | Fax consult |
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