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Current wait times:
To see a cardiologist = 1-3 days
Stress testing = 3-7 days
Echocardiogram = 3-7 days
Holter monitoring = 1-3 days
Stress echo = 2-7 days
Coronary angiography = 2-7 days
 


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Patient Information
Last Name* First Name*
Date of Birth (mm/dd/yyyy)* Gender*
Address*
City* Province*
Postal Code* HIN:  #
Version Code:  Primary Contact : 
Secondary Contact:  Email: 
Clinical Information
Referral :
Consultation Investigations
Reason :      
Other
Pertinent Clinical Information:
 
Attached:
REQUEST FOR INVESTIGATION
PHYSICIAN INFORMATION
Referring Physician*
 
Family Physician*
   
 
 
 
 
 
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