Get St. Michael's Hospital Vascular Surgery Clinic Referral Form

Filling out the St. Michael's Hospital Vascular Surgery Clinic Referral Form online can help streamline the referral process for patients and healthcare providers. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the referral form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Select the type of referral needed by checking either the 'Elective Consultation' or 'Urgent Consultation' box.
3. Fill in the date to document when the referral is being made. This is important for tracking and urgency purposes.
4. Complete the 'Patient Information' section by providing the patient’s name, phone number, date of birth, OHIP number, and address.
5. In the 'Clinical History (symptoms)' section, indicate the clinical indications relevant to the patient's condition by checking the appropriate boxes, or specify other symptoms if necessary.
6. Provide details about the referring physician in the 'Referring Physician' section by entering their name, phone number, signature, billing number, and fax number.
7. Review all entered information for accuracy and completeness before proceeding.
8. Once satisfied with the information, save your changes. You can also download, print, or share the completed form directly from the editor.

Complete the referral form online to ensure timely processing and care.