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.
If you are a referring healthcare provider, please CLICK HERE for more information.
General Requisitions for Cardiology & Radiology Services:
- Greater Toronto Area
- Huntsville
- Lindsay
- Sault Ste. Marie
- Southwestern Ontario (Brantford, London, Sarnia & Simcoe)
- Sudbury – Cardiology
- Sudbury – Radiology
Specialty Requisitions:
- Brampton – Sleep Disorders
- London – Pain Injections
- Mississauga – PET/CT
- Ontario – Same-Week Cardiology Consultations at Cardiology Now
*Our OHIP-covered services require a signed requisition from a certified Ontario healthcare provider, such as a family doctor, walk-in clinic or community health centre.