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Diagnostic Assessment Forms
 

These forms are meant for healthcare providers to download and use to refer patients to Diagnostic Assessment Programs across the province. Please direct all enquiries and completed forms directly to the appropriate Diagnostic Assessment Program.

Region / LHIN Facility Referral Form
Erie St. Clair Windsor Regional Hospital
Colorectal, Lung, Prostate
South West
Grey Bruce Health Services
Thoracic
South West
Grey Bruce Health Services Prostate
South West
London Health Sciences
Thoracic
South West
London Health Sciences
Colorectal
South West
London Health Sciences
Hepato/Pancreatic/Biliary-Rectal (HPB-R)
South West
St. Joseph's Health Care London
Prostate
Waterloo Wellington Grand River Hospital
Thoracic
Waterloo Wellington
Waterloo Wellington Regional Colonoscopy Network
Colonoscopy
Waterloo Wellington
Waterloo Wellington (Nurse Navigator)
GI, Breast, Prostate
Hamilton Niagara Haldimand Brant
St. Joseph's Hamilton, Niagara Health System and Brant Community Health System General
Lung, Esophageal
Mississauga Halton / Central West
Trillium Health Partners, Mississauga Halton/Central West Regional Cancer Program Breast
Mississauga Halton / Central West
Trillium Health Partners, Mississauga Halton/Central West Regional Cancer Program Hepato-Pancreatic-Biliary
Mississauga Halton / Central West
Trillium Health Partners, Mississauga Halton/Central West Regional Cancer Program Thoracic
Mississauga Halton / Central West
Trillium Health Partners, Mississauga Halton/Central West Regional Cancer Program Rectal
Toronto Central (South) Mount Sinai Hospital Colorectal
Toronto Central (South) University Health Network Breast
Toronto Central (South) University Health Network Colorectal
Toronto Central (South) University Health Network Thoracic
Toronto Central (North)
Sunnybrook Health Sciences Centre
Colorectal
Lung
Central
North York General Hospital
Prostate
Toronto Central (North)
Michael Garron Hospital
Lung
Toronto Central (North)
Michael Garron Hospital
Thyroid
Toronto Central (North)
Michael Garron Hospital
Breast
Central
Southlake
Breast
Central
Southlake
Lung
Central Southlake Colorectal
Central Southlake
Prostate
Central East
Lakeridge Health, Peterborough Regional Health Centre and Rouge Valley Centenary
Thoracic
Central East
Lakeridge Health
Prostate
Central East
Lakeridge Health
Colorectal
South East
Kingston General Hospital
Lung
South East Hotel Dieu, Kingston Colorectal
Champlain The Ottawa Hospital
Cancer Assessment Clinic and Ottawa Regional Women's Breast Health Centre
Breast, Lung, Colorectal, Prostate
North Simcoe Muskoka Royal Victoria Hospital
Nurse Navigator - Rectal
North East
Health Sciences North
Colonoscopy
North East North East Cancer Centre Lung
North East Sault Area Hospital
(Algoma only)
Lung
North West Thunder Bay Regional Health Sciences Centre Lung
North West
Thunder Bay Regional Health Science Centre
Colonoscopy
Last modified: Tue, Jan 17, 2017
cancer care ontario | action cancer ontario   620 University Avenue Toronto Ontario, Canada M5G 2L7   Phone: 416.971.9800 Fax: 416.971.6888

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