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Airway Clinic Diagnostics 

Forms

Airway Clinic Diagnostics Referral Form (CFM)

updated 2025
(Coming soon)

Airway Clinic Diagnostics Referral Form (PDF)

updated 2025

Criteria

For the list of procedures offered, please review the referral form.

Cardio Respiratory and Electrodiagnostic Services

Forms

Cardio Respiratory and Electrodiagnostic Services (CFM)

updated 2023
(Coming soon)

Cardio Respiratory and Electrodiagnostic Services (PDF)

updated 2023

Cardiodiagnostic Services

Forms

Cardiodiagnostic Services Referral Form (CFM)

updated 2016
(Coming soon)

Cardiodiagnostic Services Referral Form (PDF)

updated 2016

EMG

Forms

EMG Referral Form – WRHN @ 40 Green (CFM)

updated 2025
(Coming soon)

EMG Referral Form – WRHN @ 40 Green (PDF)

updated 2025

EMG Referral Form – WRHN @ Chicopee (CFM)

updated 2025 Coming soon

EMG Referral Form – WRHN @ Chicopee (PDF)

updated 2025

Contact Us

If you have questions or need assistance, please contact:

EMG Clinic
Phone: 519-749-4235
Fax: 519-749-4312

EEG

Forms

EEG Testing Clinic Referral Form (CFM)

updated 2025
(Coming soon)

EEG Testing Clinic Referral Form (PDF)

updated 2025

Criteria

Referrals are only accepted for patients residing in Waterloo Wellington.

Contact Us

If you have questions or need assistance, please contact:

WRHN EEG Services
Phone: 519-749-4300, ext. 4603
Fax: 519-749-4241