Requisitions Forms

Instructions

Please print out and take the referral form to your physician. After your physician has completed the form, you have two options:

1) Your physician or their medical staff can book an appointment at the medical clinic of your choice.
2) You can book an appointment at the clinic of your choice.

In either case, you can use our clinic locator to find the clinic most convenient for you that offers the medical test you require. Please remember to bring your health card and your completed requisition to your appointment.

Ontario - Medical Imaging, Vascular Ultrasound, CT, MRI

Brantford - Medical Imaging Requisition

GTA Central & GTA East - Medical Imaging Requisition

GTA Central & GTA West - Medical Imaging Requisition

Kitchener - Medical Imaging Requisition

Oakville - 1525 Cornwall Road - Vascular Ultrasound Requisition 

Ontario - CT / MRI - Medical Imaging Requisition

Ottawa - Medical Imaging Requisition

St. Catharines - Medical Imaging Requisition

Toronto - 1881 Yonge Street - Vascular Ultrasound Requisition

British Columbia - BMD, Breast Imaging, MRI, Mammography, X-ray, Ultrasound, Medical Imaging

Victoria - BMD Requisition

Victoria - Breast Imaging Requisition

Victoria - MRI Requisition

Victoria - Screening Mammography Program Requisition

Victoria - X-ray / Ultrasound Requisition

Vancouver - X-ray / Ultrasound / Mammograpy / BMD / MRI Requisition

Vancouver - MRI Requisition

Victoria - Chiropractor - Medical Imaging Requisition

Victoria - Dentist - Medical Imaging Requisition

Alberta - MRI, Mammograpy, X-ray, Ultrasound, BMD, Medical Imaging

Calgary - General (Open MRI, MYK, K.I.D.S., CWIC) - MRI, Mammography, X-Ray, Ultrasound and BMD Requisition

Calgary - Open MRI of Canada - Open MRI Requisition

Calgary - Kids Imaging & Diagnostic Specialists (K.I.D.S.) - Pediatric & Adolescent X-Ray and Ultrasound Requisition

Calgary - Calgary Women's Imaging Centre (CWIC) - Medical Imaging Requisition

Edmonton - Medical Imaging Requisition