General Surgery

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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In an effort to save time and increase efficiency, the Division of General Surgery is now accepting referrals electronically via the Ocean eReferral Platform. The Division of General Surgery at London Health Sciences Centre has been moved over to the Ocean eReferral system and we would prefer all new patient referrals to be sent via this platform. 
The goal of the division is to receive all new patient referrals for hernia, gallbladder and colonoscopy through central intake via the Ocean eReferral platform. 
While we understand not all physicians are using the Ocean eReferral platform, we are encouraging you to register with Ocean eReferral. During this transition period, we will accept requests via email to [email protected] or fax to 519-685-8273 (please be sure to use the new forms linked below)

General Clinic Forms

Handout re LHSC Gen Surg Dept. Transition to Ocean

General FormsServicesLocationFormContactInformation
Colonoscopy – Gen Surg
While we understand not all physicians are using the Ocean eReferral platform, we are encouraging you to register with Ocean eReferral. During this transition period, we will accept requests by email to [email protected] or fax to 519-685-8273 using this form.
1. ColonoscopyLHSC – University Hospital
LHSC – Victoria Hospital
SEE NOTE TO THE LEFTPhone: 519-685-8500 ext. 57420Ocean eReferral
Inguinal/Umbilical Hernia & Gallbladder Surgery
While we understand not all physicians are using the Ocean eReferral platform, we are encouraging you to register with Ocean eReferral. During this transition period, we will accept requests by email to [email protected] or fax to 519-685-8273 using this form.
1. Inguinal Hernia Repair
2. Umbilical Hernia Repair
3. Gallbladder Disease
LHSC – University Hospital
LHSC – Victoria Hospital
SEE NOTE TO THE LEFTPhone: 519-685-8500 ext. 57420Ocean eReferral
Colorectal Cancer Diagnostic Referral1. CCO Colorectal Cancer ReferralLHSC – Victoria Hospital

St. Joseph’s Hospital
CCO SWLHIN Colorectal Program Info & ReferralPhone: 519-685-8500 Ext.56928
LHSC Fax: 519-663-3020
SJH Fax: 519-646-6114
Fax consult
Rectal Cancer Diagnostic Referral1. CCO Rectal Cancer Referral CCO SWLHIN Rectal ReferralPhone: 519-685-8500 Ext.53232
Fax: 519-432-1805
Fax consult
Hepato/Pancreatic/Biliary (HPB) Cancer Diagnostic Referral1. CCO Hepato/Pancreatic/Biliary Cancer Referral CCO SWLHIN HPB ReferralPhone: 519-685-8500 Ext.36742
Fax: 519-663-3047
Fax consult
Strathroy Endoscopy – Gen Surg1. Colonoscopy
2. Gastroscopy
Strathroy Middlesex General HospitalStrathroy Endoscopy ReferralFax:
Elgamal 519-245-8305
Jain 519-246-6319
Manji 519-930-3019
Fax consult

London Physicians

*Some physicians also have subspecialty/interest in Breast Cancer Surgery, and Bariatrics. All breast-related referrals must be sent specifically to St. Joseph’s Hospital – Breast Care Program. Submit Bariatric referrals to the Ontario Bariatric Network Portal: https://www.ontariobariatricnetwork.ca/. Do not send Breast Surgery/Bariatric referrals to the General Surgery dept as they will be deleted.

London PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Alkhamesi, Nawar1. General Surgery
2. Colorectal Surgery
LHSC – University HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-663-3985Ocean eReferral
Dr. Brackstone, Muriel1. General Surgery
2. Colorectal Cancer Surgery
3. Gallbladder Surgery
4. Hernia Repair
5. Breast Surgery
LHSC – Victoria HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-685-8712Ocean eReferral
Speaks French
Dr. Colquhoun, Patrick1. General Surgery
2. Colorectal Surgery Focus: Cancer, IBD, Ano-rectal pathology
3. Gallbladder Surgery
4. Hernia Repair
5. Colonoscopy
6. Breast Surgery
LHSC – University HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-663-3287Ocean eReferral
Dr. Davies, Edward1. General Surgery
2. Hepatobiliary and Pancreatic Surgeon
3. Breast Surgery
LHSC – University HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-663-3458Ocean eReferral
Dr. Elnahas, Ahmad1. General Surgery
2. Minimally Invasive Surgery
3. Bariatric Surgery
LHSC – University HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-663-3612Ocean eReferral
Speaks Arabic
Dr. Gray, Daryl1. General Surgery
2. Endocrine (Thyroid, Pancreas, Adrenal Glands)
3. Colorectal Surgery
4. Colonoscopy
LHSC – Victoria HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-667-6583Ocean eReferral
Dr. Hawel, Jeffrey1. General Surgery
2. Advanced laproscopic Surgery
3. Advanced Endoscopy & ERCP
LHSC – University HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-663-2963Ocean eReferral
Dr. Latosinsky, Steven1. Colorectal Cancer Surgery
2. Melanoma Excision
3. Surgical Oncology
4. Breast Surgery
LHSC – London Regional Cancer ProgramMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-685-8740Ocean eReferral
Dr. Leeper, Rob1. General Surgery
2. Complex Abdominal Wall Reconstruction
LHSC – Victoria HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-685-8547Ocean eReferral
Dr. Leslie, Kenneth1. General Surgery
2. Hepatobiliary and Pancreatic Surgery
3. ERCP
LHSC – Victoria HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-667-6778Ocean eReferral
Dr. Ott, Michael1. General Surgery
2. Colorectal Surgery
LHSC – Victoria HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-685-8260Ocean eReferral
Dr. Parry, Neil1. General Surgery
2. Complex Abdominal Wall Reconstruction
3. Colonoscopy
LHSC – Victoria HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-667-6583Ocean eReferral
Dr. Quan, Douglas1. General Surgery
2. Hepatobiliary and Pancreatic Surgery & Transplant Surgery
LHSC – University HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-663-3355Ocean eReferral
Dr. Saettler, Elizabeth1. General Surgery Oncology
2. Melanoma & Non-Melanoma Skin Cancer Excision
3. Breast Surgery
London Health Sciences Centre – London Regional Cancer ProgramMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-685-8500 ext 53658Ocean eReferral
Dr. Schlachta, Christopher1. General Surgery
2. Advanced Laparoscopic and Robotic Surgery
3. Colorectal Surgery
4. Bariatric Surgery
LHSC – University HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-663-3478Ocean eReferral
Dr. Skaro, Anton1. General Surgery
2. Hepatopancreatobiliary Surgery,
3. Transplant Surgery
LHSC – University HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-685-8500 Ext. 32904Ocean eReferral
Dr. Van Koughnett, Julie Ann1. General Surgery
2. Colorectal Surgery
3. Colonoscopy
LHSC – University HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-663-3312Ocean eReferral
Dr. Smith, Shane1. General Surgery
2. Vascular Surgery
LHSC – University HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Ocean eReferral
Dr. Tang, Ephraim1. General Surgery
2. Hepatobiliary and Pancreatic Surgery
3. Transplant Surgery
4. ERCP
LHSC – University HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-663-2920Ocean eReferral
Dr. Zwiep, Terry1. General Surgery
2. Colorectal Surgery
LHSC – Victoria HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-685-8260Ocean eReferral
Dr. Maciver, Allison1. General Surgery
2. General Surgical Oncology
3. Breast Surgery
LHSC – Victoria HospitalMust refer via Ocean
Referral Form for fax/email during temporary transition period
Phone: 519-685-8500 Ext. 53658Ocean eReferral

St. Thomas Physicians

St. Thomas PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Armstrong, Jeffrey1. General Surgery236 Elm St
St Thomas, ON
N5R 1J5
Generic FormPhone: 519-631-0567
Fax: 519-631-0921
Fax consult
Dr. Black, Robert1. General Surgery236 Elm St
St Thomas, ON
N5R 1J5
Generic FormPhone: 519-631-0567
Fax: 519-631-0921
Fax consult
Dr. Bottoni, David1. General Surgery236 Elm St
St Thomas, ON
N5R 1J5
Generic FormPhone: 519-631-0567
Fax: 519-631-0921
Fax consult
Dr. Collins, Paul1. General Surgery236 Elm St
St Thomas, ON
N5R 1J5
Generic FormPhone: 519-631-0567
Fax: 519-631-0921
Fax consult
Dr. Zhuruk, Alexandr1. General Surgery
2. Minimally Invasive Surgery
236 Elm St
St Thomas, ON
N5R 1J5
Generic FormPhone: 519-631-0567
Fax: 519-631-0921
Fax consult
Speaks Russian & Ukrainian

Stratford Physicians

Stratford PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Dilabio, Tony1. General SurgeryStratford General HospitalGeneric FormPhone: 519-273-4100
Fax: 519-273-3208
Fax consult
Website
Dr. Lefebvre, Kevin1. General SurgeryStratford General HospitalGeneric FormPhone: 519-273-4100 ext 5
Fax: 519-273-3208
Fax consult
Website
Dr. Maruscak, Adam1. General SurgeryStratford General HospitalGeneric FormPhone: 519-273-4100 ext 3
Fax: 519-273-3208
Fax consult
Website
Dr. McCune, Marcie1. General SurgeryStratford General HospitalGeneric FormPhone: 519-273-4100 ext 4
Fax: 519-273-3208
Fax consult
Website
Dr. McWilliam, Morgan1. General SurgeryStratford General HospitalGeneric FormPhone: 519-273-4100
Fax: 519-273-3208
Fax consult
Website
Dr. O’Neill, Craig1. General SurgeryStratford General HospitalGeneric FormPhone: 519-273-4100 ext 6
Fax: 519-273-3208
Fax consult
Website

Strathroy Physicians

Strathroy PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Elgamal, Akram1. General Surgery
2. Colorectal Surgery
Strathroy Middlesex General Hospital
Bradley Medical Centre
595 Bradley Ave
London, ON
N6E 3Z8
Generic Form
Strathroy Endoscopy Referral
Phone: Strathroy 519-245-8392
BradleyOffice: 519-685-7229

Fax: Strathroy 519-245-8305
Bradley Office: 519-685-3085
Fax consult
Dr. Jain, Vipan1. General SurgeryStrathroy Middlesex General HospitalGeneric Form
Strathroy Endoscopy Referral
Phone: 519-246-6321
Fax: 519-246-6319
Fax consult
Dr. Manji, Farouq1. General SurgeryStrathroy Middlesex General HospitalStrathroy Endoscopy ReferralPhone: 519-930-3019
Fax: 519-286-1622
Fax consult
Dr. Rajagopalan, Aarthi1. General Surgery
2. Endoscopy
310 Wellington Rd
London, ON
N6C 4P4 
Strathroy Middlesex General Hospital
Generic FormPhone: 519-433-4700
Fax: 519-433-4702
Fax consult
Speaks Hindi & Tamil

Woodstock Physicians

Woodstock PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. El-Salviti, Gamal1. General Surgery510 Ingersoll Ave, Suite 102
Woodstock, ON
N4S 4X9
Generic FormPhone: 519-421-1996
Fax: 519-421-3334
Fax consult
Speaks Arabic
Dr. Metz, Jeffrey1. General Surgery748 Dundas St
Woodstock, ON N5S 1E9
Generic FormPhone: 519-539-6622
Fax: 519-290-3558
Fax consult
Dr. Humphrey, Robert1. General Surgery333 Athlone Ave, Suite 106
Woodstock, ON
N4V 0B8
Generic FormPhone: 519-539-6622
Fax: 519-539-7954
Fax consult
Dr. MacLeod, Malcolm1. General Surgery
2. Newborn Circumcisions (24-48hr old)
600 Princess St, Suite 300
Woodstock, ON
N4S 4H4
Generic FormPhone: 519-539-4866
Fax: 519-539-4867
Fax consult
Speaks French
Dr. Swart, Maritza1. General Surgery
2. Newborn Circumcisions (24-48hr old)
333 Athlone Ave, Suite 102
Woodstock, ON
N4V 0B8
Generic FormPhone: 519-290-0192
Fax: 519-290-0957
Fax consult
Speaks Afrikaans

Goderich Physicians

Goderich PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Daters, Aaron1. General SurgeryAlexandra Marine and General HospitalGeneric FormPhone: 519-524-8689
Fax: 519-524-8527
Fax consult
Dr. Kittmer, Tiffaney1. General Surgery
2. Minimally Invasive Surgery
3. Carpal Tunnel Surgery
4. Endoscopy
5. Wound Management
Alexandra Marine and General HospitalGeneric FormPhone: 519-524-8689 ext 5208
Fax: 519-524-8527
Fax consult
Speaks French

Tillsonburg Physicians

Tillsonburg PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Colaco, Carmo Domingos1. General Surgery17 Bear St (office)
Tillsonburg ON
N4G 1V4
Generic FormPhone: 519-842-3611
Fax: 519-842-9668
Fax consult
Dr. Crosby, Jacqueline1. General Surgery
2. General Surgical Oncology
17 Bear St (office)
Tillsonburg ON
N4G 1V4
Generic FormPhone: 519-842-2101
Fax: 519-842-9668
Fax consult

Hanover, Walkerton, Listowell Physicians

Hanover, Walkerton & Listowell PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Duque-Rendon, Hector1. General SurgeryHanover and District HospitalGeneric FormPhone: 519-364-0910
Fax: 519-364-0920
Fax consult
Speaks Spanish
Dr. Kieffer, Kellan1. General SurgeryHanover and District HospitalGeneric FormPhone: 519-364-0910
Fax: 519-364-0920
Fax consult
Dr. Graham, Duncan1. General SurgerySouth Bruce Grey Health Centre – WalkertonGeneric FormPhone: 519-881-2880
Fax: 519-370-2425
Fax consult

Pediatric Physicians

Pediatric PhysiciansSubspecialty / InterestLocationFormContactInformation
Dr. Butter, Andreana1. Pediatric General Surgery
2. Congenital Diaphragmatic Hernia
3. Chest Wall Deformities
4. Robotic Surgery
Children’s Hospital London Health Sciences CentreGeneric FormPhone: 519-685-8401
Fax: 519-685-8421
Fax consult
Speaks French & Dutch
Dr. Lam, Jennifer1. Pediatric General SurgeryChildren’s Hospital London Health Sciences CentreGeneric FormPhone: 519-685-8500 ext 71553
Fax: 519-685-8019
Fax consult
Dr. Merritt, Neil1. Pediatric General Surgery
2. Neonatal Surgery
3. Chest Wall Deformities
4.Pediatric Trauma
Children’s Hospital London Health Sciences CentreGeneric FormPhone: 519-685-8454
Fax: 519-685-8465
Fax consult
Dr. Scott, Leslie1. Pediatric General Surgery
2. Adult Breast Surgeon
Children’s Hospital London Health Sciences CentreGeneric FormPhone: 519-685-8571
Fax: 519-685-8241
Fax consult

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