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:

Specialty Requisitions:

*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.