Cardiac Catheterization & Percutaneous Coronary Intervention (PCI) Referral Forms

Provincial Cath Referral Forms for Adult Patients

Please note:

  • Fax completed cath-referral form to the Regional Cardiac Care Coordinator at one of the following centres: Regional Cardiac Care Coordinators Contact Information
  • Do not fax the cath-referral form to the Provincial Office but directly to one of the contacts at a cardiac centre.
  • This form is for use by referring physicians only; referrals for cath cannot be made by patients or other non-physicians.
  • Written approval following the accountability framework is required before any arrangements are made.
  • This form can be used for referrals to all Ontario cath centres except those in Hamilton and Ottawa. Contact these cardiac centres directly to obtain the form used by each centre.

Forms - PLEASE FAX ALL FORMS TO REFERRAL HOSPITAL - DO NOT FAX TO CORHEALTH ONTARIO