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
Clinics
| Clinics | Subspecialty / Interest | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Urgent GI Clinic (VH Only) | 1. Gastroenterology | LHSC – Victoria Hospital | VH Outpatient Referral | Phone: 519-667-6582 Fax: 519-667-6820 | Fax consult |
| Strathroy Endoscopy | 1. Colonoscopy 2. Gastroscopy | Strathroy Middlesex General Hospital | Strathroy Endoscopy Referral | Fax: Elgamal 519-245-8305 Jain 519-246-6319 | Fax consult |
London
| London | Subspecialty / Interest | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Dr. Beaton, Melanie | 1. Gastroenterology 2. Hepatology | LHSC – University Hospital | Generic Form | Phone: 519-663-3344 Fax: 519-663-3220 | Fax consult |
| Dr. Adams, Paul | 1. Gastroenterology 2. Hepatology 3.Genetic Hemochromatosis 4. Liver Transplant | LHSC – University Hospital | Generic Form | Phone: 519-685-8500 ext 35375 Fax: 519-663-3549 | Fax consult |
| Dr. Jairath, Vipul | 1. Gastroenterology 2. IBD 3. Endoscopy | LHSC – University Hospital | Generic Form | Phone: 519-663-3655 Fax: 519-663-3658 | Fax consult |
| Dr. Khanna, Reena | 1. Gastroenterology 2. IBD | LHSC – University Hospital | Generic Form | Phone: 519-685-8500 ext 34945 Fax: 519-663-3700 | Fax consult |
| Dr. Marotta, Paul | 1. Hepatology 2. Liver Transplant 3. Liver Cancer | 230 Victoria Street, Suite 226 London, On N6A 2C2 | Generic Form | Phone: 519-873-1750 Fax: 519-873-1715 | Fax consult |
| Dr. Qumosani, Karim | 1. Gastroenterology 2. Hepatology 3. Liver Transplant | LHSC – University Hospital | Generic Form | Phone: 519-663-3976 Fax: 519-663-2907 | Fax consult Speaks Arabic |
| Dr. Gregor, James | 1. Gastroenterology 2. IBD | LHSC – Victoria Hospital | Generic Form | Phone: 519-667-6582 Fax: 519-667-6820 | Fax consult |
| Dr. Asfaha, Samuel | 1. Gastroenterology 2. Colorectal Cancer | LHSC – Victoria Hospital | Generic Form | Phone: 519-685-8500 ext 76582 Fax: 519-667-6820 | Fax consult |
| Dr. Chande, Nilesh | 1. Gastroenterology 2. IBD | LHSC – Victoria Hospital | Generic Form | Phone: 519-667-6582 Fax: 519-690-0492 | Fax consult |
| Dr. Ponich, Terry | 1. Gastroenterology 2. IBD 3. ERCP 4. Pancreatic & Biliary Disease | LHSC – Victoria Hospital | Generic Form | Phone: 519-667-6852 Fax: 519-667-6820 | Fax consult |
| Dr. Sandhu, Amindeep | 1. Gastroenterology | LHSC – Victoria Hospital | Generic Form | Phone: 519-667-6582 Fax: 519-667-6820 | Fax consult |
| Dr. Sey, Michael | 1. Gastroenterology 2. Colonoscopy 3. Small Bowel Endoscopy 4. Advanced Endoscopy Procedures 5. Capsule Endoscopy | LHSC – Victoria Hospital | Generic Form | Phone: 519-667-6582 Fax: 519-667-6820 | Fax consult |
| Dr. Wilson, Aze | 1. Gastroenterology 2. IBD 3. Celiac Disease | LHSC – Victoria Hospital | Generic Form | Phone: 519-663-3832 Fax: 519-663-3220 | Fax consult |
| Dr. Yan, Brian | 1. Gastroenterology 2. IBD 3. Endoscopic Ultrasound 4. Advanced Endoscopy | LHSC – Victoria Hospital | Generic Form | Phone: 519-667-6582 Fax: 519-667-6820 | Fax consult |
| Dr. Hussain, Nadeem | 1. Gastroenterology 2. Endoscopic Ultrasound 3. Advanced Endoscopy | St. Joseph Healthcare Centre | Generic Form | Phone: 519-646-6100 ext 64312 Fax: 519-646-6130 | Fax consult |
| Dr. Khanna, Nitin | 1. Gastroenterology 2. ERCP 3. Advanced Endoscopy | St. Joseph Healthcare Centre | Generic Form | Phone: 519-646-6125 Fax: 519-646-6130 | Fax consult |
| Dr. McIntosh, Keith | 1. Gastroenterology 2. Esophageal Disease | St. Joseph Healthcare Centre | Generic Form | Phone: 519-646-6100 ext 61312 Fax: 519-646-6130 | Fax consult |
| Dr. Rahman, Adam | 1. Gastroenterology 2. TPN & Feeding Tubes 3. Dysmotility Syndromes 4. Celiac Disease | St. Joseph Healthcare Centre | Generic Form | Phone: 519-646-6000 ext 64320 Fax: 519-646-6130 | Fax consult |
| Dr. Townsend, Cassandra | 1. Gastroenterology 2. IBD | LHSC – Victoria Hospital | Generic Form | Phone: 519-667-6582 Fax: 519-667-6820 | Fax consult |
Southwestern Ontario
| Southwestern Ontario | Subspecialty / Interest | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Dr. Thomas, Benson | 1. Gastroenterology 2. Hepatology 3. Liver Transplant | St. Thomas Elgin General Hospital | Generic Form | Phone: 519-631-2030 Fax: 519-631-6143 | Fax consult |
| Dr. Jawaid, Noor | 1. Gastroenterology 2. Hepatology | Woodstock General Hospital | Generic Form | Phone: 519-539-7844 Fax: 519-290-3320 | Fax consult |
Pediatric
| Pediatric | Subspecialty / Interest | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Dr. Ashok, Dhandapani | 1. Pediatric Gastroenterology 2. IBD 3. Hepatology | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8792 Fax: 519-685-8105 | Fax Consult Website |
| Dr. Bax, Kevin | 1. Pediatric Gastroenterology | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8177 Fax: 519-685-8105 | Fax Consult Website |
| Dr. Zizzo, Andreanne | 1. Pediatric Gastroenterology 2. Hepatology | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8177 Fax: 519-685-8105 | Fax Consult Website |
| Dr. Atkison, Paul | 1. Pediatric Gastroenterology 2. Pediatric Liver Transplant | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8354 Fax: 519-685-8105 | Fax Consult Website |
| Dr. Crowley, Eileen | 1. Pediatric Gastroenterology 2. IBD | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8354 Fax: 519-685-8105 | Fax Consult Website |
| Dr. Woolfson, Jessica | 1. Pediatric Gastroenterology 2. Nutrition | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8354 Fax: 519-685-8105 | Fax Consult Website |
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