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 | Location | Form | Contact | Information |
|---|---|---|---|---|
| St. Joseph Allergy, Asthma, COPD, Respiratory Clinics | SJHC 3rd Floor Zone B | Allergy Referral FormPFT Referral Form | Phone: 519-646-6000 Asthma: ext: 66128 COPD Ext: 66158 PFT Lab: 61389 Fax Numbers: Allergy: 519-646-6292 PFT: 519-646-6164 | Fax to SJHC Website |
| Pulmonary Function Lab Strathroy Middlesex General Hospital | Strathroy Middlesex General Hospital | Pulmonary Function Laboratory Requisition | Phone: 519-245-5295 ext. 5440 Fax: 519-246-5919 | Fax form |
London Physicians
| London Physicians | Location | Form | Contact | Information |
|---|---|---|---|---|
| Dr. Dhaliwal, Inderdeep | LHSC – Victoria Hospital | Generic Form | Phone: 519-667-6596 Fax: 519-685-8406 | Fax Consult |
| Dr. Farquhar, Donald | 775 Waterloo Street, Unit 5 London ON N6A 3W5 | Generic Form | Phone: 226-663-0667 Fax: 519-433-5468 | Fax Consult |
| Dr. George, Frederick | LHSC – Victoria Hospital | Generic Form | Phone: 519-667-6860 Fax: 519-685-8406 | Fax Consult |
| Dr. Kashgari, Alia | LHSC – Victoria Hospital | Generic Form | Phone: 519-685-8094 Fax: 519-685-8406 | Fax Consult Speaks Arabic |
| Dr. Licskai, Christopher | LHSC – Victoria Hospital | Generic Form | Phone: 519-646-6405 Fax: 519-685-8406 | Fax Consult |
| Dr. Mackenzie, Constance (Clinical Pharmacology) | St. Joseph’s Hospital | Generic Form | Phone: 519-667-6767 Fax: 519-685-8406 | Fax Consult Speaks German |
| Dr. Mehta, Sanjay | LHSC – Victoria Hospital | Generic Form | Phone: 519-667-6723 Fax: 519-685-8406 | Fax Consult Speaks French & Hindi |
| Dr. Mura, Marco | LHSC – Victoria Hospital | Generic Form | Phone: 519-685-6744 Fax: 519-685-8406 | Fax Consult Speaks Italian |
| Dr. Povitz, Marcus | LHSC – Victoria Hospital | Generic Form | Phone: 519-685-8500 x 53085 Fax: 519-685-8406 | Fax Consult |
| Dr. Yamashita, Cory | St. Joseph’s Hospital | Generic Form | Phone: 519-646-6000 x 65283 Fax: 519-646-6404 | Fax Consult |
St. Thomas Physicians
| St. Thomas Physicians | Location | Form | Contact | Information |
|---|---|---|---|---|
| Dr. Rozanski, Camilla | St. Thomas Elgin General Hospital | Generic Form | Phone: 519-631-1380 Fax: 519-631-6143 | Fax consult |
Pediatric Physicians
| Pediatric Physicians | Location | Form | Contact | Information |
|---|---|---|---|---|
| Dr. Lyttle, Brian (Pediatric Resp) | 239 Oxford St. E., London, ON N6A 1V2 l | Generic Form | Phone: 519-433-2242 Fax: 519-645-7565 | Fax Consult |
| Dr. Price, April (Pediatric Resp) | LHSC – Victoria Hospital | Generic Form | Phone: 519-685-8500 x 58824 Fax: 519-685-8156 | Fax Consult |
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Get all the London-area eForms for OSCAR, JUNO, Avaros, THT, Indivicare here
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