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
| Clinic | Services | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Driving Assessment Program (Paid service) | 1. DriveABLE2. Driver Assessment and Rehab Program (DARP) | Parkwood Hospital | Drive Assessment Form | Phone: 519-685-4070 Fax: 519-685-4066 | Fax Referral Website |
| Regional Geriatric Services | Outpatient 1. Geriatric Consultation 2. Aging Brain & Memmory Clinic 3. Psychogeriatric Outreach 4. Geriatric Program (office or home visit) 5. Continence Clinic 6. Geriatric Mental Health 7. Geriatric Day Hospital 8. Third Age OutreachInpatient 1. Geriatric Rehab Unit 2. MSK Rehab Unit 3. Acquired Brain Injury Rehab 4. Spinal Cord Injury Rehab 5. Stroke/Neuro Rehab | Parkwood Hospital | GAAT Referral Form (Outpatient) Inpatient Geriatric Referral | Phone: 519-685-4046 Fax: 519-685-4020 | Fax Referral for centralized intake Please call access Office they are happy to discuss referrals Outpatient Website Inpatient Website |
| SJHC Osteoporosis Clinic | 1. Osteoporosis Management | St. Joseph’s Healthcare Centre Room B4-084 | SJHC Osteoporosis Referral | Phone: 519 646-6100 ext. 64434 Fax: 519 646-6183 | Fax consult Website |
London Physicians
| Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Dr. Borrie, Michael | 1. Geriatrician 2. Cognitive Impairment / Dementia 3. Geriatric Rehabilitation | Parkwood Hospital Main Building 550 Wellington Rd, A2-129 London, ON | GAAT Referral Form | Phone: 519-685-4021 Fax: 519-685-4020 | Fax consult |
| Dr. Diachun, Laura | 1. Geriatrician | Parkwood Hospital Main Building 550 Wellington Rd, A2-129 London, ON | GAAT Referral Form | Phone: 519-685-4021 Fax: 519-685-4020 | Fax consult |
| Dr. Kane, Sheri-Lynn | 1. Geriatrician | Parkwood Hospital Main Building 550 Wellington Rd, A2-129 London, ON | GAAT Referral Form | Phone: 519-685-4021 Fax: 519-685-4020 | Fax consult |
| Dr. Peel, Alexandrea | 1. Geriatrician | Parkwood Hospital Main Building 550 Wellington Rd, A2-129 London, ON | GAAT Referral Form | Phone: 519- 685-4069 Fax: 519-685-4020 | Fax consult |
| Dr. Wells, Jennie | 1. Geriatrician | Parkwood Hospital Main Building 550 Wellington Rd, A2-129 London, ON | GAAT Referral Form | Phone: 519-685-4021 Fax: 519-685-4020 | Fax consult |
| Dr. Thain, Jenny | 1. Geriatrician 2. Osteoporosis | LHSC – Victoria Hospital | Osteoporosis Referral Form | Phone: 519-685-8816 Fax: 519 646-6183 | Fax consult |
| Dr. Brymer, Chris | 1. Geriatrician 2. Cognitive Impairment / Dementia | LHSC – University Hospital | GAAT Referral Form | Phone: 519-663-3922 Fax: 519-685-4020 | Fax consult |
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