RESOURCES
Requisition Forms
Download your patient requisition form.
If you are a patient, please click on your region below to download a PDF requisition and obtain a signed copy from your referring healthcare provider*. Then CLICK HERE to find your nearest WELL Health Diagnostic Centre with contact information.
*Our OHIP and AHCIP-covered services require a signed requisition from a certified provincial healthcare provider, such as a family doctor, walk-in clinic or community health centre.
If you are a referring healthcare provider, please CLICK HERE for more information.
General Requisitions:
- Airdrie – Diabetes and Endocrinology
- Calgary – Cardiology
- Calgary – Diabetes and Endocrinology
- Edmonton – Diabetes and Endocrinology
- Greater Toronto Area – Cardiology and Radiology
- Huntsville – Cardiology and Ultrasound
- Lindsay – Cardiology and Radiology
- Sarnia – Cardiology and Radiology
- Sault Ste. Marie – Cardiology and Radiology
- Southwestern Ontario (Brantford, London, Sarnia and Simcoe) – Cardiology and Radiology
- Sudbury – Cardiology
- Sudbury – Radiology
Specialty Requisitions: