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 | Subspecialty / Interest | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Specialty Health Clinic (SHC) | Ontario-wide HIV PrEP & Viral Hepatitis Virtual Clinic | Virtual/Ontario-wide | SHC Referral Form | Fax: 226-785-0986 | Fax consult |
| Hepatitis Clinic lead by: Cheryl Dale RN(EC) MScN AF-AASLD, Hepatology Nurse Practitioner | HepB, HepC | Virtual/Ontario-wide | Hepatitis Referral Form | Phone: 519-902-2066 Fax: 519-936-7982 | Fax consult, attach relevant lab/imaging results |
Adult Physicians
| Adult | Subspecialty / Interest | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Dr. Bondy, Lise | 1. Hep C/HIV co-infection 2. General Infectious Diseases | St. Joseph’s Health Care London 268 Grosvenor Street | Generic Referral Form | Phone: 519-646-6415 Fax: 519-646-6040 | Fax consult – include bloodwork |
| Dr. Devlin, Megan | 1. HIV 2. General Infectious Diseases 3. Tropical Diseases | “ | “ | Phone: 519-646-6207 Fax: 519-646-6040 | “ |
| Dr. Elsayed, Sameer | 1. General Infectious Diseases | “ | “ | Phone: 519-685-8726 Fax: 519-685-8109 | “ Speaks Arabic |
| Dr. MacPherson, Douglas | 1. General Infectious Diseases | 189 Elm St, St Thomas, ON N5R 5C4 | “ | Phone: 519-631-1380 Fax: 519-207-9200 | Fax consult – include bloodwork |
| Dr. Shalhoub, Sarah | 1. Transplant Infectious Diseases 2. General Infectious Diseases | St. Joseph’s Health Care London 268 Grosvenor Street | “ | Phone: 519-646-6323 Fax: 519-646-6328 | “ |
| Dr. Silverman, Michael | 1. General Infectious Diseases 2. HIV / AIDS 3. Hep C 4. Fecal transplant for recurrent C.Diff | “ | “ | Phone: 519-646-6311 Fax: 519-646-6328 | “ |
| Dr. Thompson, Bill | 1. Diabetic feet managment 2. HIV 3. General Infectious Diseases | 310 Wellington Road London, ON N6C4P4; St. Josephs Health Care London | London Diabetes Foot Clinic Referral Form | Phone: 519-663-3849 Fax: 519-432-6266 | “ |
Pediatric Physicians
| Pediatric Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
|---|---|---|---|---|---|
| Dr. Barton-Forbes, Michelle | 1. Congenital infections 2. Pediatric Infectious Diseases | Children’s Hospital, London Health Sciences Centre | Generic Referral Form | Phone: 519-685-8500 ext. 58299 Fax: 519-685-8156 | Fax consult |
| Dr. Nashid, Nancy | 1. Congenital infections 2. Pediatric HIV 3. Pediatric Infectious Diseases | “ | Phone: 519-685-8500 ext. 58299 | “ | |
| Dr. Salvadori, Marina | “ | “ | “ | Phone: 519-685-8299 Fax: 519-685-8156 | Fax consult Speaks Romanian |
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