Internal Medicine

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.

Clinics

Clinic	Services	Location	Form	Contact	Information
Victoria Hospital ER Urgent Medicine	1. Urgent Medicine Clinic	LHSC – Victoria Hospital	VH Urgent Medicine Referral VH ER Urgent Medicine Pt Handout	Fax: 519-685-8751	-Clerk to Book -Fax consult with ER Sheet -VH ER Only
St. Joseph’s Hospital UCC Urgent Medicine	1. Urgent Medicine Clinic	St. Joseph’s Healthcare Centre	SJ UCC Urgent Medicine Referral	Fax: 519-646-6064	-Fax consult with ER Sheet -They will call patient -SJHC UCC Only

University Hospital – London Physicians

University Hospital Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Appleton, Andrew	1. Internal Medicine	LHSC – University Hospital	Generic Form	Phone: 519-663-3071 Fax: 519-663-3073	Fax consult
Dr. Goldszmidt, Mark	1. Internal Medicine 2. Complex Medical Care	LHSC – University Hospital	Generic Form	Phone: 519-685-8500 ext 35995 Fax: 519-663-3062	Fax consult
Dr. Gryn, Steven	1. Internal Medicine 2. Clinical Pharmacology & Toxicity	LHSC – University Hospital	Generic Form	Phone: 519-663-2922 Fax: 519-663-3217	Fax consult
Dr. Hackam, Dan	1. Internal Medicine 2. Clinical Pharmacology & Toxicity	LHSC – University Hospital	Generic Form	Phone: 519-531-5731 Fax: 519-931-5737	Fax consult
Dr. Huda, Noureen –	1. Internal Medicine	LHSC – University Hospital	Generic Form	Phone: 519-685-8500 ext 33024 Fax: 519-663-2908	Fax consult
Dr. Kim, Richard	1. Internal Medicine 2. Clinical Pharmacology & Toxicity	LHSC – University Hospital	Dr. Kim Personalized Med Referral	Phone: 519-663-3553 Fax: 519-663-3090	Fax consult
Dr. Mrkobrada, Marko	1. Internal Medicine	LHSC – University Hospital	Generic Form	Phone: 519-685-8500 ext 33170 Fax: 519-663-3414	Fax consult
Dr. Myers, Kathryn	1. Internal Medicine 2. Hypertension 3. Vascular Risk Reduction	LHSC – University Hospital	Generic Form	Phone: 519-646-6142 Fax: 519-663-3291	Fax consult
Dr. Yu, Jeffrey	1. Internal Medicine	LHSC – University Hospital	Generic Form	Phone: 519-663-2958 Fax: 519-663-3062	Fax consult

Victoria Hospital – London Physicians

Victoria Hospital Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Brownscombe, Larry	1. Internal Medicine	LHSC – Victoria Hospital	Generic Form	Phone: 519-685-8166 Fax: 519-685-8166	Fax consult
Dr. Dresser, George	1. Internal Medicine 2. Clinical Pharmacology & Toxicology	LHSC – Victoria Hospital	Generic Form	Phone: 519-663-3342 Fax: 519-663-3388	Fax consult
Dr. Moore, Mary	1. Internal Medicine 2. Opthamology (Ocular Inflammatory Disease) 3. Peri-Operative Medicine	LHSC – Victoria Hospital	Generic Form	Phone: 519-667-6676 Fax: 519-472-4614	Fax consult
Dr. Patrick, Larry	1. Internal Medicine 2. Cardiology 3. Cardiac Rehab	LHSC – Victoria Hospital	Generic Form	Phone: 519-685-8315 Fax: 519-685-8316	Fax consult
Dr. Salim, Hatem	1. Internal Medicine	LHSC – Victoria Hospital	Generic Form	Phone: 519-685-8500 Ext. 58132 Fax: 519-685-8357	Fax consult Speaks Arabic
Dr. Sun, Dongmei	1. Internal Medicine 2. Medical Disorders in Pregnancy	LHSC – Victoria Hospital	Generic Form	Phone: 519-685-8500 ext 57034 Fax: 1-888-789-6130	Fax consult Speaks Mandarin
Dr. Wyllie, Blair	1. Internal Medicine 2. Nephrology	LHSC – Victoria Hospital	Generic Form	Phone: 519-685-8132 Fax: 519-685-8357	Fax consult
Dr. Zafar, Saira	1. Internal Medicine	LHSC – Victoria Hospital	Generic Form	Phone: 519-685-8500 ext 58132 Fax: 519-685-8357	Fax consult Speaks Hindi, Punjabi, Urdu

St. Joseph’s Hospital – London Physicians

St. Joseph’s Hospital Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Gilbert, Kenneth	1. Internal Medicine 2. Peri-Operative Medicine	St. Joseph’s Healthcare Centre	Generic Form	Phone: 519-646-6000 ext 64674 Fax: 1-888-678-3469	Fax consult Speaks French
Dr. Larocque, Brian	1. Internal Medicine	St. Joseph’s Healthcare Centre	Generic Form	Phone: 519-646-6100 Fax: 519-646-6064	Fax consult

Community London Physicians

Community London Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Khan, Airudin	1. Internal Medicine	279 Wharncliffe Rd N, Suite 223 London, ON N6H 2C2	Generic Form	Phone: 519-679-0351 Fax: 519-679-7867	Fax consult
Dr. Leblanc, Herve	1. Internal Medicine	641 Commissioners Rd E, Suite 105 London, ON N6G 2T9	Generic Form	Phone: 519-686-8585 Fax: 519-686-8580	Fax consult
Dr. Martell, Rafael	1. Internal Medicine 2. Cardiology	219 Oxford St W, Suite 102A London, ON N6H 1S5	Generic Form	Phone: 519-432-3771 Fax: 519-432-3814	Fax consult Speaks Spanish
Dr. Patel, Paulum	1. Internal Medicine 2. Clinical Immunology	Deveron Medical Clinic #7-1166 Commissioners Road E, London, ON N5Z4W8	Generic Form	Phone: 519-668-6226 Fax: 519-668-7244	Fax consult
Dr. Sanatani, Irina	1. Internal Medicine	190 Wortley Rd, Suite 205 London, ON N6C 4Y7	Generic Form	Phone: 519-204-6727 Fax: 519-649-5055	Fax consult Speaks Russian
Dr. Nnaemeka, Ukwuoma	1. Internal medicine 2. Diabetes 3. Weight management	140 Oxford Street East London ON N6A 5R9	Generic Form	Phone: 519-850-3800 Fax: 519-850-5099	Fax consult

Stratford Physicians

Stratford Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Barry, Catherine	1. Internal Medicine	444 Douro St, Suite 107 Stratford, ON N5A 0E6	Stratford Internal Medicine Associates	Phone: 519-273-0100 Fax: 519-273-0675	Fax consult
Dr. Caines, Angela	1. Internal Medicine 2. Diabetes in Pregnancy	444 Douro St, Suite 107 Stratford, ON N5A 0E6	Stratford Internal Medicine Associates	Phone: 519-273-0100 Fax: 519-273-0675	Fax consult
Dr. Dhillon, Yadwinder	1. Internal Medicine	444 Douro St, Suite 107 Stratford, ON N5A 0E6	Stratford Internal Medicine Associates	Phone: 519-273-0100 Fax: 519-273-0675	Fax consult Speaks Hindi, Punjabi, Russian
Dr. Haffner, Thomas	1. Internal Medicine	444 Douro St, Suite 107 Stratford, ON N5A 0E6	Stratford Internal Medicine Associates	Phone: 519-273-1900 Fax: 519-273-0675	Fax consult
Dr. Kara, Ali	1. Internal Medicine	444 Douro St, Suite 107 Stratford, ON N5A 0E6	Stratford Internal Medicine Associates	Phone: 519-273-1900 Fax: 519-273-0675	Fax consult
Dr. Narayan, Shanil	1. Internal Medicine	444 Douro St, Suite 107 Stratford, ON N5A 0E6	Stratford Internal Medicine Associates	Phone: 519-273-0100 Fax: 519-273-0675	Fax consult
Dr. Peirce, Michael	1. Internal Medicine 2. Diabetes in Pregnancy	444 Douro St, Suite 107 Stratford, ON N5A 0E6	Stratford Internal Medicine Associates	Phone: 519-273-0100 Fax: 519-273-0675	Fax consult
Dr. Van Oosten, Erik	1. Internal Medicine	444 Douro St, Suite 107 Stratford, ON N5A 0E6	Stratford Internal Medicine Associates	Phone: 519-273-0100 Fax: 519-273-0675	Fax consult
Dr. Nicholson, Janis	1. Internal Medicine	Stratford General Hospital	Generic Form	Phone: 519-271-2120 Fax: 519-272-8199	Fax consult
Dr. Tamblyn, Charles	1. Internal Medicine	236 Ontario St Stratford, ON N5A 3H5	Generic Form	Phone: 519-273-2681 Fax: 519-273-4533	Fax consult

Strathroy Physicians

Strathroy Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Gomes, David	1. Internal Medicine	Strathroy Middlesex General Hospital	Generic Form	Phone: 519-245-5180 Fax: 519-245-3391	Fax consult Speaks Portuguese
Dr. Sanders, David	1. Internal Medicine 2. Cardiology	Strathroy Middlesex General Hospital	Generic Form	Phone: 519-245-4290 Fax: 519-245-4627	Fax consult
Dr. Soliman, Samy	1. Internal Medicine 2. Cardiology	Strathroy Middlesex General Hospital	Generic Form	Phone: 519-245-5295 ext 5130 Fax: 519-245-4354	Fax consult Speaks Arabic

St. Thomas Physicians

St. Thomas Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Chehadi, Waleed	1. Internal Medicine 2. Cardiology 3. Diabetes	St Thomas Elgin General Hospital	Generic Form	Phone: 519-207-9100 Fax: 519-207-9200	Fax consult
Dr. Hawken, Katherine	1. Internal Medicine	St Thomas Elgin General Hospital	Generic Form	Phone: 519-631-1380 Fax: 519-631-6143	Fax consult
Dr. McIntyre, Kathryn	1. Internal Medicine	St Thomas Elgin General Hospital	Generic Form	Phone: 519-207-9100 Fax: 519-207-9200	Fax consult
Dr. Sardar, Zahid	1. Internal Medicine 2. Cardiology	120 Wellington St St Thomas, ON N5R 2R4	Generic Form	Phone: 519-633-9200 Fax: 519-633-2391	Fax consult

Woodstock & Ingersoll Physicians

Ingersoll & Woodstock Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Hanoman, Marguerite	1. Internal Medicine	185 Oxford St Ingersoll, ON N5C 2V8	Generic Form	Phone: 519-485-5829 Fax: 519-485-1903	Fax consult
Dr. Al-Mane, Faisal	1. Internal Medicine 2. Cardiology	300 Main street Unit 1 Woodstock ON N4S 1T3	Generic Form	Phone: 519-421-3323 Fax: 519-421-3933	Fax consult
Dr. Fullerton, Gary	1. Internal Medicine 2. Cardiology	437 Norwich Ave Woodstock, ON N4S 3W5	Generic Form KMH Cardiology	Phone: 519-539-1261 Fax: 519-539-8737	Fax consult

Goderich & Tillsonburg Physicians

Goderich & Tillsonburg Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Fiaani, Majed	1. Internal Medicine 2. Cardiology	Alexandra Marine and General Hospital	Generic Form	Phone: 519-524-8323 ext 5602 Fax: 519-524-8527	Fax consult
Dr. Abdalla, Mohamed	1. Internal Medicine	Tillsonburg District Memorial Hospital	Generic Form	Phone: 519-842-3611 Fax: 519-842-6733	Fax consult Speaks French and Swahili

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