Skip to Main Content

If you are looking for forms and information about cardiodiagnostic tests, please visit Diagnostic Testing.

Cardiac Catheterization

Forms

Criteria

Please include the required test results and documentation listed in the referral checklist with your referral.

Contact Us

If you have questions or need assistance, please contact:

Regional Cardiac Care Coordinator
Cardiac Catheterization and Angioplasty
Phone: 519-749-6541
Fax: 519-749-6606

Cardiac Rehabilitation

Forms

Cardiovascular Surgery

Forms

Contact Us

If you have questions or need assistance, please contact:

Corrie Brubacher, Regional Cardiac Care Coordinator
Cardiac Surgery
Email: [email protected]
Phone: 519-749-6578, ext. 1936
Fax: 519-749-6414

Heart Function Clinic

Forms

Criteria

Please review the referral criteria listed on the form and include the required test results and documentation with your referral.

Heart Rhythm Program

Forms

Criteria

Please include the required test results and documentation listed on the form with your referral.

Contact Us

If you have questions or need assistance, please contact:

Sherry Hohl, Regional Cardiac Care Coordinator
Heart Rhythm Program
Email: [email protected]
Phone: 519-749-6578, ext. 1500
Fax: 519-749-6589

PREVENT Clinic

Forms

Criteria

Patients must be considered high risk or at increased risk for cardiovascular disease and have documented, poorly controlled, modifiable cardiac risk factors. These may include uncontrolled hypertension, high cholesterol, Type 2 diabetes, current smoking, or a family history of early-onset coronary disease in a first-degree relative, among others.

Contact Us

If you have questions or need assistance, please contact:

Phone: 226-806-5911
Fax: 226-806-5912

Structural Heart Program

Forms

Criteria

Please include the required test results and documentation listed on the form with your referral.

Contact Us

If you have questions or need assistance, please contact:

Rebecca Gies, Regional Cardiac Care Coordinator
TAVI & Structural Heart Programs
Email: [email protected]
Phone: 519-749-6578, ext. 1992
Fax: 519-749-6414

Transcatheter Aortic Valve Implantation Program

Forms

Criteria

Please include the required test results and documentation listed on the form with your referral.

Contact Us

If you have questions or need assistance, please contact:

Rebecca Gies, Regional Cardiac Care Coordinator
TAVI & Structural Heart Programs
Email: [email protected]
Phone: 519-749-6578, ext. 1992
Fax: 519-749-6414