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 | Patient Handout | Contact | Information |
---|---|---|---|---|---|
Acute Care Eye Clinic – Ivey Eye Institute | 1. Urgent Ophthalmology *Open 24/7 usually seen within 24 hours* | St Joseph’s Hospital – Ivey Eye Institute | Directions | Phone: 519-646-6100 ext. 66018Call Resident On-call for Urgent Matters 519-646-6000 | Website |
London Physicians
London Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Allen, Larry | 1. Comprehensive Ophthalmology 2. Oculo-Plastic Surgery | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-646-6366 Fax: 519-646-6418 | Fax consult |
Dr. Anderson, Matthew | 1. Comprehensive Ophthalmology 2. Retina | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-682-8250 Fax: 519-646-6251 | Fax consult |
Dr. Bursztyn, Lulu | 1. Comprehensive Ophthalmology 2. Neuro-ophthalmology 3. Cataract 4. Botox Treatment | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-646-6214 Fax: 519-646-6129 | Fax consult |
Dr. Fraser, John | 1. Neuro-ophthalmology ONLY (Neurologist) | LHSC – University Hospital | Generic Form | Phone: 519-663-3702 Fax: 519-663-3999 | Fax consult |
Dr. Gonder, John | 1. Vitreo Retinal Surgery & Diseases | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-685-8206 Fax: 519-646-6314 | Fax consult |
Dr. Hooper, Philip | 1. Vitreo Retinal Surgery & Diseases | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-685-8312 Fax: 519-646-6160 | Fax consult |
Dr. Hutnik, Cindy | 1. Comprehensive Ophthalmology 2. Glaucoma 3. Cataracts | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-646-6272 Fax: 519-646-6410 | Fax consult |
Dr. Iordanous, Yiannis | 1. Comprehensive Ophthalmology (Adult & Peds) 2. Strabismus Surgery 3. Cataract Surgery | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-646-6074 Fax: 519-646-6112 | Fax consult |
Dr. Li, Bo | 1. Cataract Surgery 2. Anterior Segment Surgery (Complex) | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-646-6287 Fax: 519-646-6216 | Fax consult |
Dr. Lin, Tony | 1. Glaucoma 2. Cataract Surgery | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-646-6225 Fax: 519-646-6218 | Fax consult |
Dr. Makar, Inas | 1. Pediatric Ophthalmology 2. Adult & Pediatric Strabismus | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-685-8281 Fax: 519-646-6149 | Fax consult |
Dr. Mather, Rookaya | 1. Cornea (Cataract, Laser) 2. External Disease 3. Inflammatory & Infectious Eye Diseases | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-646-6409 Fax: 519-646-6394 | Fax consult |
Dr. McIlraith, Ian | 1. Glaucoma 2. Cataract Surgery | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-646-6208 Fax: 519-646-6412 | Fax consult |
Dr. Motolko, Michael | 1. Glaucoma 2. Cataract Surgery | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-685-8131 Fax: 519-646-6273 | Fax consult |
Dr. Li, Bo | 1. Ophthalmology | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-646-6287 Fax: 519-646-6216 | Fax consult |
Dr. Proulx, Alain | 1. Comprehensive Ophthalmology 2. Neuro-ophthalmology | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-646-6315 Fax: 519-646-6193 | Fax consult Speaks French |
Dr. Sharan, Sapna | 1. Pediatric Ophthalmology 2. Adult & Pediatric Strabismus 3. Pediatric Glaucoma | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-685-8795 Fax: 519-646-6094 | Fax consult Speaks Hindi |
Dr. Sheidow, Thomas | 1. Vitreo Retinal Surgery & Diseases ONLY (Including Peds) | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-685-8133 Fax: 519-646-6355 | Fax consult |
Dr. Tingey, David | 1. Glaucoma 2. Cataract Surgery | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-685-8351 Fax: 519-646-6076 | Fax consult |
London Community Physicians
London Community Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Bains, Richard | 1. Comprehensive Ophthalmology 2. Laser Refraction | TLC Laser Center 142 Fullarton St London, ON N6A 0A4 | Generic Form | Phone: 519-438-2020 Fax: 519-438-2021 | Fax consult Website |
Dr. Schulz, David | 1. Comprehensive Ophthalmology | Seaforth Community Health Centre 28 Centennial Drive, Seaforth, Ontario | Generic Form | Phone: 226-633-5888 Fax: 226-633-5777 | Fax consult Website |
Dr. Mailer, Colin | 1. Comprehensive Ophthalmology | Hakim London King 215 King St London, ON N6A 1C9 Peaker Optical 1984 Dundas St E London, ON N5V 1P5 | Generic Form | Phone: Hakim 519-439-0277 Peaker 519-451-5417 Fax: Hakim 519-439-0279 Peaker 519-451-0644 | Fax consult Speaks French, German, Spanish |
St. Thomas Physicians
St. Thomas Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Brydon, Wilfred | 1. Comprehensive Ophthalmology *NO vitreal injections for diabetes or macular degeneration | St Thomas Family Health Centre 230 First Ave, Suite 110 St Thomas, ON N5R 4P5 | Generic Form | Phone: 519-633-9846 Fax: 519-637-8321 | Fax consult |
Strathroy Physicians
Strathroy Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Rogelstad, Michael | 1. Comprehensive Ophthalmology | Strathroy Middlesex General Hospital | Generic Form | Phone: 519-246-1610 Fax: 519-246-1611 | Fax consult |
Woodstock Physicians
Woodstock Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Johnson, David | 1. Comprehensive Ophthalmology 2. Refractive Laser Surgery | 695 Canterbury St, Unit 2 Woodstock, ON N4S 8W7 | Generic Form | Phone: 519-537-5052 Fax: 519-539-0476 | Fax consult |
Dr. Lui, Derek | 1. Comprehensive Ophthalmology 2. Vitreoretinal Diseases 3. Glaucoma 4. Cataract Surgery | 369 Hunter St Woodstock, ON N4S 4G3 | Generic Form | Phone: 519-421-1851 Fax: 519-421-9234 | Fax consult |
Stratford Physicians
Stratford Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Bains, Richard | 1. Comprehensive Ophthalmology 2. Laser Refraction | London Eye Surgery 1140 Southdale Rd W London, ON N6B 3R828 Centennial Drive Seaforth, ON N0K 1W0 | Generic Form | Phone: London 519-204-8200 Seaforth 519-527-8424 Fax: London 519-204-8700 Seaforth 519-527-8423 | Fax consult Website |
Pediatric Physicians
Pediatric Physicians | Subspecialty / Interest | Location | Form | Contact | Information |
---|---|---|---|---|---|
Dr. Iordanous, Yiannis | 1. Comprehensive Ophthalmology (Adult & Peds) 2. Strabismus Surgery 3. Cataract Surgery | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-646-6074 Fax: 519-646-6112 | Fax consult |
Dr. Makar, Inas | 1. Pediatric Ophthalmology 2. Adult & Pediatric Strabismus | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-685-8281 Fax: 519-646-6149 | Fax consult |
Dr. Sharan, Sapna | 1. Pediatric Ophthalmology 2. Adult & Pediatric Strabismus 3. Pediatric Glaucoma | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-685-8795 Fax: 519-646-6094 | Fax consult Speaks Hindi |
Dr. Sheidow, Thomas | 1. Vitreo Retinal Surgery & Diseases ONLY (Including Peds) | St Joseph’s Hospital – Ivey Eye Institute | Generic Form | Phone: 519-685-8133 Fax: 519-646-6355 | Fax consult |
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