Referrals and Requisitions
This section is for Health Care Professionals to utilize only.
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 check the OCEAN Health Map for more information.
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:
Acute Cardiac Evaluation Services Form
Anesthesia Procedural Clinic Referral Form
Anesthetic Consult Request Referral Form
Cardiac Diagnostics Referral Form
Cardiac Rehabilitation Referral Form
Couchiching Ontario Health Team Care Clinic Referral Form
General Genetics Referral Form
Mammography Bone Density Exam Form
Mental Health Outpatient Services Referral Form
Outpatient Rehabilitation Services Referral Form
Paediatric Eating Disorder Program Referral Form
Pregnancy Related Dilation and Curettage Referral Form and Patient Information
Respiratory Testing Referral Form
Surgery Booking Request Form - OSMH Surgeon Use Only
Videoflouroscopy Referral Form
If you should require a referral form not listed above, please contact the phone number below.
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