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.
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)
Table of Contents
General Clinic Forms
Handout re LHSC Gen Surg Dept. Transition to Ocean
General Forms | Services | Location | Form | Contact | Information |
---|---|---|---|---|---|
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. Colonoscopy | LHSC – University Hospital LHSC – Victoria Hospital | SEE NOTE TO THE LEFT | Phone: 519-685-8500 ext. 57420 | Ocean 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 LEFT | Phone: 519-685-8500 ext. 57420 | Ocean eReferral |
Colorectal Cancer Diagnostic Referral | 1. CCO Colorectal Cancer Referral | LHSC – Victoria Hospital St. Joseph’s Hospital | CCO SWLHIN Colorectal Program Info & Referral | Phone: 519-685-8500 Ext.56928 LHSC Fax: 519-663-3020 SJH Fax: 519-646-6114 | Fax consult |
Rectal Cancer Diagnostic Referral | 1. CCO Rectal Cancer Referral | CCO SWLHIN Rectal Referral | Phone: 519-685-8500 Ext.53232 Fax: 519-432-1805 | Fax consult | |
Hepato/Pancreatic/Biliary (HPB) Cancer Diagnostic Referral | 1. CCO Hepato/Pancreatic/Biliary Cancer Referral | CCO SWLHIN HPB Referral | Phone: 519-685-8500 Ext.36742 Fax: 519-663-3047 | Fax consult | |
Strathroy Endoscopy – Gen Surg | 1. Colonoscopy 2. Gastroscopy | Strathroy Middlesex General Hospital | Strathroy Endoscopy Referral | Fax: 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 Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Alkhamesi, Nawar | 1. General Surgery 2. Colorectal Surgery | LHSC – University Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-663-3985 | Ocean eReferral |
Dr. Brackstone, Muriel | 1. General Surgery 2. Colorectal Cancer Surgery 3. Gallbladder Surgery 4. Hernia Repair 5. Breast Surgery | LHSC – Victoria Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-685-8712 | Ocean eReferral Speaks French |
Dr. Colquhoun, Patrick | 1. General Surgery 2. Colorectal Surgery Focus: Cancer, IBD, Ano-rectal pathology 3. Gallbladder Surgery 4. Hernia Repair 5. Colonoscopy 6. Breast Surgery | LHSC – University Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-663-3287 | Ocean eReferral |
Dr. Davies, Edward | 1. General Surgery 2. Hepatobiliary and Pancreatic Surgeon 3. Breast Surgery | LHSC – University Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-663-3458 | Ocean eReferral |
Dr. Elnahas, Ahmad | 1. General Surgery 2. Minimally Invasive Surgery 3. Bariatric Surgery | LHSC – University Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-663-3612 | Ocean eReferral Speaks Arabic |
Dr. Gray, Daryl | 1. General Surgery 2. Endocrine (Thyroid, Pancreas, Adrenal Glands) 3. Colorectal Surgery 4. Colonoscopy | LHSC – Victoria Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-667-6583 | Ocean eReferral |
Dr. Hawel, Jeffrey | 1. General Surgery 2. Advanced laproscopic Surgery 3. Advanced Endoscopy & ERCP | LHSC – University Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-663-2963 | Ocean eReferral |
Dr. Latosinsky, Steven | 1. Colorectal Cancer Surgery 2. Melanoma Excision 3. Surgical Oncology 4. Breast Surgery | LHSC – London Regional Cancer Program | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-685-8740 | Ocean eReferral |
Dr. Leeper, Rob | 1. General Surgery 2. Complex Abdominal Wall Reconstruction | LHSC – Victoria Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-685-8547 | Ocean eReferral |
Dr. Leslie, Kenneth | 1. General Surgery 2. Hepatobiliary and Pancreatic Surgery 3. ERCP | LHSC – Victoria Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-667-6778 | Ocean eReferral |
Dr. Ott, Michael | 1. General Surgery 2. Colorectal Surgery | LHSC – Victoria Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-685-8260 | Ocean eReferral |
Dr. Parry, Neil | 1. General Surgery 2. Complex Abdominal Wall Reconstruction 3. Colonoscopy | LHSC – Victoria Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-667-6583 | Ocean eReferral |
Dr. Quan, Douglas | 1. General Surgery 2. Hepatobiliary and Pancreatic Surgery & Transplant Surgery | LHSC – University Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-663-3355 | Ocean eReferral |
Dr. Saettler, Elizabeth | 1. General Surgery Oncology 2. Melanoma & Non-Melanoma Skin Cancer Excision 3. Breast Surgery | London Health Sciences Centre – London Regional Cancer Program | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-685-8500 ext 53658 | Ocean eReferral |
Dr. Schlachta, Christopher | 1. General Surgery 2. Advanced Laparoscopic and Robotic Surgery 3. Colorectal Surgery 4. Bariatric Surgery | LHSC – University Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-663-3478 | Ocean eReferral |
Dr. Skaro, Anton | 1. General Surgery 2. Hepatopancreatobiliary Surgery, 3. Transplant Surgery | LHSC – University Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-685-8500 Ext. 32904 | Ocean eReferral |
Dr. Van Koughnett, Julie Ann | 1. General Surgery 2. Colorectal Surgery 3. Colonoscopy | LHSC – University Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-663-3312 | Ocean eReferral |
Dr. Smith, Shane | 1. General Surgery 2. Vascular Surgery | LHSC – University Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Ocean eReferral | |
Dr. Tang, Ephraim | 1. General Surgery 2. Hepatobiliary and Pancreatic Surgery 3. Transplant Surgery 4. ERCP | LHSC – University Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-663-2920 | Ocean eReferral |
Dr. Zwiep, Terry | 1. General Surgery 2. Colorectal Surgery | LHSC – Victoria Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-685-8260 | Ocean eReferral |
Dr. Maciver, Allison | 1. General Surgery 2. General Surgical Oncology 3. Breast Surgery | LHSC – Victoria Hospital | Must refer via Ocean Referral Form for fax/email during temporary transition period | Phone: 519-685-8500 Ext. 53658 | Ocean eReferral |
St. Thomas Physicians
St. Thomas Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Armstrong, Jeffrey | 1. General Surgery | 236 Elm St St Thomas, ON N5R 1J5 | Generic Form | Phone: 519-631-0567 Fax: 519-631-0921 | Fax consult |
Dr. Black, Robert | 1. General Surgery | 236 Elm St St Thomas, ON N5R 1J5 | Generic Form | Phone: 519-631-0567 Fax: 519-631-0921 | Fax consult |
Dr. Bottoni, David | 1. General Surgery | 236 Elm St St Thomas, ON N5R 1J5 | Generic Form | Phone: 519-631-0567 Fax: 519-631-0921 | Fax consult |
Dr. Collins, Paul | 1. General Surgery | 236 Elm St St Thomas, ON N5R 1J5 | Generic Form | Phone: 519-631-0567 Fax: 519-631-0921 | Fax consult |
Dr. Zhuruk, Alexandr | 1. General Surgery 2. Minimally Invasive Surgery | 236 Elm St St Thomas, ON N5R 1J5 | Generic Form | Phone: 519-631-0567 Fax: 519-631-0921 | Fax consult Speaks Russian & Ukrainian |
Stratford Physicians
Stratford Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Dilabio, Tony | 1. General Surgery | Stratford General Hospital | Generic Form | Phone: 519-273-4100 Fax: 519-273-3208 | Fax consult Website |
Dr. Lefebvre, Kevin | 1. General Surgery | Stratford General Hospital | Generic Form | Phone: 519-273-4100 ext 5 Fax: 519-273-3208 | Fax consult Website |
Dr. Maruscak, Adam | 1. General Surgery | Stratford General Hospital | Generic Form | Phone: 519-273-4100 ext 3 Fax: 519-273-3208 | Fax consult Website |
Dr. McCune, Marcie | 1. General Surgery | Stratford General Hospital | Generic Form | Phone: 519-273-4100 ext 4 Fax: 519-273-3208 | Fax consult Website |
Dr. McWilliam, Morgan | 1. General Surgery | Stratford General Hospital | Generic Form | Phone: 519-273-4100 Fax: 519-273-3208 | Fax consult Website |
Dr. O’Neill, Craig | 1. General Surgery | Stratford General Hospital | Generic Form | Phone: 519-273-4100 ext 6 Fax: 519-273-3208 | Fax consult Website |
Strathroy Physicians
Strathroy Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Elgamal, Akram | 1. 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, Vipan | 1. General Surgery | Strathroy Middlesex General Hospital | Generic Form Strathroy Endoscopy Referral | Phone: 519-246-6321 Fax: 519-246-6319 | Fax consult |
Dr. Manji, Farouq | 1. General Surgery | Strathroy Middlesex General Hospital | Strathroy Endoscopy Referral | Phone: 519-930-3019 Fax: 519-286-1622 | Fax consult |
Dr. Rajagopalan, Aarthi | 1. General Surgery 2. Endoscopy | 310 Wellington Rd London, ON N6C 4P4 Strathroy Middlesex General Hospital | Generic Form | Phone: 519-433-4700 Fax: 519-433-4702 | Fax consult Speaks Hindi & Tamil |
Woodstock Physicians
Woodstock Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. El-Salviti, Gamal | 1. General Surgery | 510 Ingersoll Ave, Suite 102 Woodstock, ON N4S 4X9 | Generic Form | Phone: 519-421-1996 Fax: 519-421-3334 | Fax consult Speaks Arabic |
Dr. Metz, Jeffrey | 1. General Surgery | 748 Dundas St Woodstock, ON N5S 1E9 | Generic Form | Phone: 519-539-6622 Fax: 519-290-3558 | Fax consult |
Dr. Humphrey, Robert | 1. General Surgery | 333 Athlone Ave, Suite 106 Woodstock, ON N4V 0B8 | Generic Form | Phone: 519-539-6622 Fax: 519-539-7954 | Fax consult |
Dr. MacLeod, Malcolm | 1. General Surgery 2. Newborn Circumcisions (24-48hr old) | 600 Princess St, Suite 300 Woodstock, ON N4S 4H4 | Generic Form | Phone: 519-539-4866 Fax: 519-539-4867 | Fax consult Speaks French |
Dr. Swart, Maritza | 1. General Surgery 2. Newborn Circumcisions (24-48hr old) | 333 Athlone Ave, Suite 102 Woodstock, ON N4V 0B8 | Generic Form | Phone: 519-290-0192 Fax: 519-290-0957 | Fax consult Speaks Afrikaans |
Goderich Physicians
Goderich Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Daters, Aaron | 1. General Surgery | Alexandra Marine and General Hospital | Generic Form | Phone: 519-524-8689 Fax: 519-524-8527 | Fax consult |
Dr. Kittmer, Tiffaney | 1. General Surgery 2. Minimally Invasive Surgery 3. Carpal Tunnel Surgery 4. Endoscopy 5. Wound Management | Alexandra Marine and General Hospital | Generic Form | Phone: 519-524-8689 ext 5208 Fax: 519-524-8527 | Fax consult Speaks French |
Tillsonburg Physicians
Tillsonburg Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Colaco, Carmo Domingos | 1. General Surgery | 17 Bear St (office) Tillsonburg ON N4G 1V4 | Generic Form | Phone: 519-842-3611 Fax: 519-842-9668 | Fax consult |
Dr. Crosby, Jacqueline | 1. General Surgery 2. General Surgical Oncology | 17 Bear St (office) Tillsonburg ON N4G 1V4 | Generic Form | Phone: 519-842-2101 Fax: 519-842-9668 | Fax consult |
Hanover, Walkerton, Listowell Physicians
Hanover, Walkerton & Listowell Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Duque-Rendon, Hector | 1. General Surgery | Hanover and District Hospital | Generic Form | Phone: 519-364-0910 Fax: 519-364-0920 | Fax consult Speaks Spanish |
Dr. Kieffer, Kellan | 1. General Surgery | Hanover and District Hospital | Generic Form | Phone: 519-364-0910 Fax: 519-364-0920 | Fax consult |
Dr. Graham, Duncan | 1. General Surgery | South Bruce Grey Health Centre – Walkerton | Generic Form | Phone: 519-881-2880 Fax: 519-370-2425 | Fax consult |
Pediatric Physicians
Pediatric Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Butter, Andreana | 1. Pediatric General Surgery 2. Congenital Diaphragmatic Hernia 3. Chest Wall Deformities 4. Robotic Surgery | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8401 Fax: 519-685-8421 | Fax consult Speaks French & Dutch |
Dr. Lam, Jennifer | 1. Pediatric General Surgery | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8500 ext 71553 Fax: 519-685-8019 | Fax consult |
Dr. Merritt, Neil | 1. Pediatric General Surgery 2. Neonatal Surgery 3. Chest Wall Deformities 4.Pediatric Trauma | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8454 Fax: 519-685-8465 | Fax consult |
Dr. Scott, Leslie | 1. Pediatric General Surgery 2. Adult Breast Surgeon | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8571 Fax: 519-685-8241 | Fax consult |
Need eForms for your EMR system? EMR training? IT services? Online booking? Check-in kiosk? Contact us
Get all the London-area eForms for OSCAR, JUNO, Avaros, THT, Indivicare here
Contact [email protected] for any other eForm needs for OSCAR, JUNO, Avaros, THT, Indivicare, and Accuro EMRs.