Cardiac Catheterization & Percutaneous Coronary Intervention (PCI) Referral Forms

CorHealth is no longer hosting branded referral forms on our website for each facility.

CorHealth will host referral form templates on our website that can be branded and customized by each facility. The forms have been updated to reflect the CorHealth Data Collection & Information System (DCIS) dataset. This form is not appropriate for use as a referral for procedure.

Below is a list of the primary telephone and fax numbers for each facility’s coronary angiogram referral triage program. To obtain the most up-to-date version of a referral form contact that facility directly.

Please transmit the completed referral form via fax to the Regional Cardiac Care Coordinator at the facility you wish to refer to.

Please Note: Do not send any referral forms or PHI of any kind to Ontario Health – CorHealth Ontario. Please, fax it directly to one of the designated contacts at a cardiac facility.

Hamilton Health Science 905-521–2100 ext. 46674 905-527-2691
Health Sciences North 705-523-7100 ext. 5550 705-523-7102
Kingston Health Sciences Centre 613-548-1399 ext. 2 613-548-2407
London Health Sciences Centre 519-663-3069
Michael Garron Hospital 416-469-6443
Niagara Health Systems 905-521–2100 ext. 46674 905-527-2691
Peterborough Regional Health Centre 705-743-2121 ext. 3258 705-876-5155
Rouge Valley Health System 416-281-3156 or 416-281-7274
Royal Victoria Regional Health Centre 705-728-9802 ext. 46123 705-797-3077 or 905-830-5802
Sault Area Hospital Cardiac Care Coordinator: 705-759-3434 ext. 6994
Cath Lab: 705-759-3434 ext. 5811
Scarbrough Health Network 416-284-8131 ext. 5326
Cardiac Care Coordinator: 416-281-7477
Southlake Regional Health Centre 905-895-4521 ext. 2707 905-830-5802
St. Mary’s General Hospital 519-749-6541 519-749-6606
Sunnybrook Health Sciences Centre 416-480-6100 ext. 7160 or 3234 416-480-5892
Thunder Bay Regional Health Science Centre 807-684-6675 807-684-5902
Trillium Health Partners 905-848-7396 905-848-7358
University of Ottawa Heart Institute Cardiology Coordinator: 613-696-7061 (inpatients)
613-696-7064 (outpatients)
Unity Health Toronto 416-864-5455
University Health Network 416-340-3788
William Osler Health Centre 905-494-2120 ext. 58525 905-494-0280
Windsor Regional Health Centre RCCC/Cath Lab Coordinator: 519-973-4444 ext. 33156 519-973-5584