Referrals and Requisitions

This page provides access to referral / requisition templates utilized at OSMH.  We will also accept referral / requisitions not on the hospital template if they provide all information required to identify the patient, the referring clinician, the procedure requested and pertinent details.  Any incomplete or illegible referrals / requisitions will be sent back to the referring provider requesting further information before a procedure can be scheduled.

Diagnostic Imaging now accepts eReferrals! 

Please use the Central Region Diagnostic Imaging (CT/MRI) Intake Hub OCEAN Health Map

If you are a primary care provider and want to sign up for OCEAN eReferral, complete the online quick form or email eReferral@ehealthce.ca.

Referral / Requisition Forms:

Anesthesia Procedural Clinic Referral Form

Anesthetic Consult Request Referral Form

Asthma Referral Form

Bone Mineral Density Referral Form

Cardiac Diagnostics Referral Form

Cardiac Rehabilitation Referral Form

Cardioversion Request Form

CHAT Referral Form

CT Elective Exam Form - Central Intake - (for community-based referring providers)

CT Urgent/Emergent Exam Form - (for OSMH internal use or community-based referring providers requiring a scan time within 24-48 hours)

Couchiching OHT Chronic Disease Program Referral Form (for Healthcare Providers)

EEG Requisition Form

Diabetes Education - Adult Referral Form

General Genetics Referral Form

Cancer Genetics Referral Form

Interventional Procedure Form

Mammography Exam Form

Mental Health Outpatient Services Referral Form

MRI Elective Exam Form - Central Intake - (for community-based referring providers)

MRI Urgent/Emergent Exam Form (for OSMH internal use or community-based referring providers requiring a scan time within 24-48 hours)

Nuclear Medicine Exam Form

MSK-CI-Referral Form

Outpatient Nephrology Referral Form

Outpatient Rehabilitation Services Referral Form

Pregnancy Related Dilation and Curettage Referral Form and Patient Information

Respiratory Testing Referral Form

Sexual Assault & Domestic Violence Treatment Centre
Social Work Referral Form

Simcoe Muskoka Regional Eating Disorder Program Referral Form

Surgery Booking Request Form - OSMH Surgeon Use Only

Ultrasound Exam Form

Videoflouroscopy Referral Form

XRAY Exam Form

Consent to Treatment Plan or Procedure

Consent to Treatment Plan or Procedure Form

If you should require a referral form not listed above, please contact 705.325.2201 option 3.

General questions about patient scheduling can be directed to 705.325.2201 option 3.

Should you have questions about Central Scheduling and/or Scheduling practices at OSMH, please contact central scheduling or registration at 705-325-2201 Ext: 8001