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
Clinic
| Clinic | Services | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Hematology Clinic | 1. Benign Hematology 2. Malignant Hematology 3. Thrombosis 4. Bleeding Disorders | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8475 Fax: 519-685-8294 | Fax Referral Website |
London Adult Physicians
| London Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Dr. Deotare, Uday | 1. Malignant Hematology (BMT/Leukemia) 2. Stem Cell Transplant | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext. 58631 Fax: 519-685-8294 | Fax consult |
| Dr. Howson-Jan, Kang | 1. Malignant Hematology (Leukemia/Lymphoma) 2. Stem Cell Transplant | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 55232 Fax: 519-685-8294 | Fax consult |
| Dr. Hsia, Cyrus | 1. Benign Hematology 2. Transfusion Medicine | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 56060 Fax: 519-685-8294 | Fax consult |
| Dr. Kovacs, Michael | 1. Benign Hematology (General Malignant) 2. Malignant Hematology 3. Thrombosis | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 52254 Fax: 519-685-8294 | Fax consult |
| Dr. Lam, Selay | 1. Malignant Hematology (Lymphoma & Multiple Myeloma) | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8827 Fax: 519-685-8294 | Fax consult |
| Dr. Lazo-Langner, Alejandro | 1. Benign Hematology 2. Malignant Hematology (General Malignant) 3. Thrombosis | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 58833 Fax: 519-685-8294 | Fax consult Speaks Spanish |
| Dr. Louzada, Martha de Lacerda | 1. Malignant Hematology (Multiple Myeloma) 2. Thrombosis | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 52391 Fax: 519-685-8294 | Fax consult |
| Dr. Mangel, Joy | 1. Malignant Hematology (Lymphoma) | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 55232 Fax: 519-685-8294 | Fax consult Speaks French |
| Dr. Phua, Chai | 1. Malignant Hematology (Lymphoma & Multiple Myeloma) 2. Bleeding Disorders | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8342 Fax: 519-685-8294 | Fax consult Speaks Cantonese, Mandarin, Malay |
| Dr. Saini, Lalit | 1. Benign Hematology 2. Malignant Hematology (Leukemia) | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 56072 Fax: 519-685-8294 | Fax consult |
| Dr. Solh, Ziad | 1. Hemoglobinopathies 2. Transfusion Medicine 3. Peds Heme/Onc | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 56447 Fax: 519-685-8294 | Fax consult |
| Dr. Xenocostas, Anargyros | 1. Malignant Hematology 2. Stem Cell Transplant | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 58631 Fax: 519-685-8294 | Fax consult Speaks French and Greek |
| Dr. Barghi, Arvand | 1. Benign Hematology 2. Malignant Hematology (Lymphoma/Myeloma) | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 55232 Fax: 519-685-8294 | Fax consult |
| Dr. Foster, Cheryl | 1. Benign Hematology 2. Malignant Hematology (Lymphoma/Myeloma) | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 56072 Fax: 519-685-8294 | Fax consult |
| Dr. Ho, Jenny | 1. Malignant Hematology (Leukemia) | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 56072 Fax: 519-685-8294 | Fax consult |
| Dr. Philip, Shona | 1. Malignant Hematology (Lymphoma/Myeloma) | LHSC – Victoria Hospital | Hematology Referral Form | Phone: 519-685-8500 ext 56072 Fax: 519-685-8294 | Fax consult |
Pediatric Physicians
| Pediatric Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Dr. Cairney, Elizabeth Dr. Gibson, PaulDr. Jardine, LawrenceDr. Patel, SerinaDr. Solh, ZiadDr. Zelcer, ShaynaDr. Zorzi, Alexandra | 1. Pediatric Hematology & Oncology | Children’s Hospital London Health Sciences Centre | Generic Form | Phone: 519-685-8494 Fax: 519-685-8384Page for Urgent Matters or New Oncology Cases | Fax Consult Website |
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