Urology

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
Prostate Diagnostic Assessment Program	1. Prostate cancer	St. Joseph’s Hospital Room B4-602 268 Grosvenor Street London, Ontario N6A 4V2	Prostate DAP Referral Form	Phone: 519-646-6000 ext 65622 Fax: 519-646-6217	Fax Referral Website
Renal Colic New Patient Referral Form	1. Ureteral Colic	SJHC LHSC	Renal Colic Referral Form		Fax Referral
LHSC ER Urology Clinic (VH Only)	1. Urology	LHSC – Victoria Hospital	VH Outpatient Referral	Phone: 519-685-8500 x 58450 Fax: To Physicians office	Fax consult MD office will call patient

London Physicians

London Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Dave, Sumit	1. Urology 2. Pediatric Urology	LHSC – Victoria Hospital	Generic Form	Phone: 519-685-8439 Fax: 519-667-6581	Fax consult
Dr. Izawa, Jonathan	1. Urology 2. Uro-oncology Surgery NOT: Pediatrics, sexual dysfunction, female incontinence, infertility	LHSC – Victoria Hospital	Generic Form	Phone: 519-685-8550 Fax: 519-685-8455	Fax consult
Dr. Power, Nicholas	1. Urology 2. Kidney Stones 3. Uro-oncology Surgery	LHSC – Victoria Hospital	Generic Form	Phone: 519-667-6787 Fax: 519-685-8455	Fax consult
Dr. Luke, Patrick	1. Urology	LHSC – University Hospital	Generic Form	Phone: 519-663-3180 Fax: 519-663-3858	Fax consult
Dr. Sener, Alp	1. Urology	LHSC – University Hospital	Generic Form	Phone: 519-663-3352 Fax: 519-663-3858	Fax consult
Dr. Denstedt, John	1. Urology 2. Kidney Stones	St. Joseph’s Healthcare Centre	Generic Form	Phone: 519-646-6036 Fax: 519-646-6037	Fax consult
Dr. Pautler, Stephen	1. Uro-oncology Surgery (only)	St. Joseph’s Healthcare Centre	Generic Form	Phone: 519-646-6384 Fax: 519-646-6037	Fax consult
Dr. Razvi, Hassan	1. Urology 2. Kidney Stones (Will see Peds Kidney Stones)	St. Joseph’s Healthcare Centre	Generic Form	Phone: 519-646-6259 Fax: 519-646-6037	Fax consult
Dr. Welk, Blayne	1. Urology 2. Incontinence	St. Joseph’s Healthcare Centre	Generic Form	Phone: 519-646-6367 Fax: 519-646-6037	Fax consult

Stratford Physicians

Stratford Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Bukala, Bernard	1.Urology	378 Huron St, Suite A Stratford, ON N5A 5T5	Generic Form	Phone: 519-272-0064 Fax: 519-272-0447	Fax consult

St. Thomas Physicians

St. Thomas Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Cheng, Michael	1. Urology	202 Elm St St Thomas, ON N5R 1J3	Generic Form	Phone: 519-633-4034 Fax: 519-633-3412	Fax consult

Strathroy Physicians

Strathroy Physicians	Subspecialty / Interest	Location	Form	Contact	Information

Woodstock Physicians

Woodstock Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Kamal, Fadi	1.Urology	333 Athlone Ave, Suite 105 Woodstock, ON N4V 0B8	Generic Form	Phone: 519-533-6964 Fax: 519-533-6965	Fax consult
Dr. Violette, Phillppe	1.Urology 2. Kidney Stones 3. Uro-oncology Surgery 4. Circumcision	333 Athlone Ave, Suite 105 Woodstock, ON N4V 0B8	Generic Form	Phone: 519-533-6966 Fax: 519-533-6967	Fax consult

Pediatric Physicians

Pediatric Physicians	Subspecialty / Interest	Location	Form	Contact	Information
Dr. Dave, Sumit	1. Pediatric Urology	LHSC – Victoria Hospital	Generic Form	Phone: 519-685-8439 Fax: 519-685-8455	Fax consult

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