Cardiac Catheterization and Percutaneous Coronary Intervention Referral Forms

Referral form templates are hosted on the support page within the Data Collection and Information System (DCIS) that can be branded and customized by each facility. The forms have been updated to reflect the DCIS data set. This form is not appropriate for use as a referral for procedure.

This list includes primary telephone and fax numbers for each facility’s coronary angiogram referral triage program. To obtain the most up-to-date version of a referral form, contact that facility directly.

Please transmit the completed referral form via fax to the Regional Cardiac Care Coordinator at the facility you wish to refer to.

Please Note: Do not send any referral forms or Personal Health Information of any kind to Ontario Health. Please fax it directly to one of the designated contacts at a cardiac facility.

Facilities

Hamilton Health Science
Phone: 905-521–2100 ext. 46674
Fax: 905-527-2691

Health Sciences North
Phone: 705-523-7100 ext. 5550 
Fax: 705-523-7102

Kingston Health Sciences Centre
Phone: 613-548-1399 ext. 2
Fax: 613-548-2407

London Health Sciences Centre
Fax: 519-663-3069

Michael Garron Hospital
Fax: 416-469-6443

Niagara Health Systems
Phone: 905-521–2100 ext. 46674
Fax: 905-527-2691

Peterborough Regional Health Centre
Phone: 705-743-2121 ext. 3258
Fax: 705-876-5155

Rouge Valley Health System
Fax: 416-281-3156 or 416-281-7274

Royal Victoria Regional Health Centre
Phone: 705-728-9802 ext. 46123
Fax: 705-797-3077

Sault Area Hospital
Phone: 705-759-3434 ext. 6994 (Cardiac Care Coordinator)
705-759-3434 ext. 5811 (Cath Lab)
Fax: 705-256-3491

Scarbrough Health Network
Phone: 416-284-8131 ext. 5326
416-281-7477 (Cardiac Care Coordinator)
Fax: 416-284-3156

Southlake Health
Phone: 905-895-4521 ext. 2707
Fax: 905-830-5802

St. Mary’s General Hospital
Phone: 519-749-6541
Fax: 519-749-6606

Sunnybrook Health Sciences Centre
Phone: 416-480-6100 ext. 7160 or 3234
Fax: 416-480-5892

Thunder Bay Regional Health Science Centre
Phone: 807-684-6675
Fax: 807-684-5902

Trillium Health Partners
Phone: 905-848-7396
Fax: 905-848-7358

University of Ottawa Heart Institute
Phone: 613-696-7061 (Cardiology Coordinator - Inpatients)
613-696-7064 (Cardiology Coordinator - Outpatients)
Fax: 613-696-7144

Unity Health Toronto
Fax: 416-864-5455

University Health Network
Fax: 416-340-3788

William Osler Health Centre
Phone: 905-494-2120 ext. 58525
Fax: 905-494-0280

Windsor Regional Health Centre
Phone: RCCC/Cath Lab Coordinator: 519-973-4444 ext. 33156
Fax: 519-973-5584