Referral forms

Referral forms

Cancer care (oncology)

Breast Health Centre referral

Markham oncology referral

Pain and symptom management referral

Smoker's helpline referral

Stroke Prevention Clinic referral


Care transitions

Home at last referral

Seniors Home Support Program


The Stollery Family Centre for Childbirth & Children

Central intake - Obstetric Referral

Childbirth and children's services – physician referral

Neonatal Follow-up Clinic referral

Obstetrical Clinic referral (for early pregnancy assessments)

Outpatient Antenatal Consultation Request (for women planning to deliver at Markham Stouffville Hospital)

Paediatric Lifestyle Clinic and general nutrition services referral

Paediatric development and assessment referral

Paediatric Outpatient Clinic referral (PAC, newborn, endocrinology and diabetes)

Paediatric Respiratory Clinic referral


Diagnostic services

2012 CAR diagnostic imaging referral guidelines

Cardio-respiratory electrodiagnostic referral

CT/MRI interventional radiology requisition

Diagnostic imaging referral

Diagnostic imaging referral guidelines

EMG/NCS referral with neurological consultation

MRI knee appropriateness checklist

MRI spine appropriateness checklist

OBSP Ontario Breast Screening Program referral


Mental health

Outpatient mental health referral

Women's wellness services referral


Outpatient clinics

Clinical Assessment Centre Referral

Clinical telemedicine consult/referral

Clinical telemedicine consult/referral from long-term care home

COPD/Asthma referral – Centre for Respiratory Health

Colorectal Screening Program referral

Diabetes Education Centre referral

Diabetes Education Centre self referral (adult patients)

Emergency Department follow up and consultations – Uxbridge Hospital

Emergency Department Fracture Clinic referral

FIT + Colonoscopy referral

Fracture Clinic referral

Markham Melanoma and Pigmented Skin Lesion referral

Outpatient Adult Diabetes Education referral

Outpatient rehabilitation referral

Outpatient videofluroscopic swallowing study referral

Seniors' Health Clinic referral 

Sleep Disorders Lab referral

Telederm referral

Weight management referral


OJAC Referrals

Orthopaedic consultation: Knee and hip arthritis management – Dr. Haider

Orthopaedic consultation: Knee and hip arthritis management – Dr. Koo

Orthopaedic consultation: Knee and hip arthritis management – Dr. McMahon

Orthopaedic consultation: Knee and hip arthritis management – Dr. Shirali

Orthopaedic consultation: Knee and hip arthritis management – Dr. Watts

Orthopaedic consultation: Knee and hip arthritis management – General

Orthopaedic consultation: Shoulder, ankle and foot management – General


Rapid Access Clinic – Low back pain

Primary Care Provider Registration and Onboarding