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.

Referral / Requisition Forms:

Click Here for our OSMH Acute Cardiac Evaluation Services Form

Click Here for our OSMH Anesthesia Procedural Clinic Referral Form

Click Here for our Anesthetic Consult Request Referral Form

Click Here for our Asthma Referral Form

Click Here for our Cardiac Diagnostics Referral Form

Click Here for our Cardiac Rehabilitation Referral Form

Click Here for our Cardioversion Request Form

Click Here for our CHAT Referral Form

Click Here for our Couchiching Ontario Health Team Care Clinic Referral Form

Click Here for our CT Exam Form

Click Here for our EEG Requisition Form

Click Here for our General Genetics Referral Form

Click Here for our Cancer Genetics Referral Form

Click Here for our Interventional Procedure Form

Click Here for our Mammography Bone Density Exam Form

Click Here for our Mental Health Outpatient Services Referral Form

Click Here for our Nuclear Medicine Exam Form

Click Here for our MSK-CI-Referral Form

Click Here for our Outpatient Rehabilitation Services Referral Form

Click Here for our Paediatric Eating Disorder Program Referral Form

Click Here for our Pulmonary Rehabilitation Referral Form

Click Here for our Remdesivir Referral Form

Click Here for our Respiratory Testing Referral Form

Click Here for our Surgery Booking Request Form - OSMH Surgeon Use Only

Click Here for our Ultrasound Exam Form

Click Here for our Videoflouroscopy Referral Form

Click Here for our XRAY Exam 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:
Melanie Moore
Manager, Central Patient Scheduling, Registration, Admitting & Switchboard
705-325-2201 Ext. 6592