Referral forms

Many of our programs only accept referrals from physicians. Please see the referral form or program page for more information.Many clinics now accept eReferrals! Please check individual clinic pages or the OCEAN Health Map for more information.

Ocean eReferral Sign up

If you are a primary care provider and want to sign up for OCEAN eReferral, complete the online quick form or email @email.

Aftercare Program

Mental Health & Addiction Services Referral Form

Bone Mineral Densitometry

Diagnostic Imaging - General Requisition Form (2022)

Cardiology

Cardiology - Pacemaker Insertion Referral Form
Cardiology - Heart Failure Referral Form
Cardiology - Pacemaker Interrogation Referral Form
Cardiology-Cardiac Cath-Referral Form
Cardiology-Cardiac Lab-Requisition

Child & Teen Clinic

Child & Teen Clinic Referral Form

Child & Youth Mental Health Outpatient Services: For Healthcare Providers

Child & Youth Mental Health Outpatient Paper Referral Form

Child and Youth Eating Disorders Program

Child and Youth Eating Disorders Program Referral Form

Complex Continuing Care

Complex Care - Long Term Ventilation - Referral Form

Consultation Assessment Time-Limited Therapy Clinic (CATT)

Mental Health & Addiction Services Referral Form

Crisis Counselling

Mental Health & Addiction Services Referral Form

CT Scan

Diagnostic Imaging - General Requisition Form (2022)

Day Treatment Program

Day Treatment Referral

Diabetes Clinic

Endocrinology Clinic Paper Referral Form
DECNET Type 2 and Pre Diabetes Referral Form

Diabetes in Pregnancy & Gestational Diabetes Clinic

Diabetes in Pregnancy Referral Form

Diagnostic Assessment Units (DAUs)

Surgery - Diagnostic Assessment Unit (DAU) - Breast - Referral Form
Surgery - Diagnostic Assessment Unit (DAU) - Thyroid - Referral Form for referring patients to MGH Physicians
Surgery - Diagnostic Assessment Unit (DAU) - Colorectal Letter to Referring Physicians
Surgery - Diagnostic Assessment Unit (DAU) - Colorectal - Referral Form
Surgery - Diagnostic Assessment Unit (DAU) - Chest - Referral Form

Diagnostic Imaging

Diagnostic Imaging - MRI Referral Form
Diagnostic Imaging - General Requisition Form (2022)

Gastroenterology Clinic

Child & Teen Clinic Referral Form

Geriatric Assessment

Geriatric Assessment Clinic Referral Form

Interventional Procedures

Diagnostic Imaging - General Requisition Form (2022)

Long Stay ICU Program

Long Stay Critical Care Program - Screening Form
Long Stay Critical Care Program - Full Application

Mammography

Diagnostic Imaging - General Requisition Form (2022)

Medical Assessment Clinic

Medical Assessment Clinic Paper Referral Form
Infectious Disease Clinic Paper Referral Form

Mental Health, Addiction & Withdrawal Management Services

Mental Health & Addiction Services Referral Form

MRI – Magnetic Resonance Imaging

Diagnostic Imaging - MRI Referral Form

Multi-disciplinary Care Kidney Clinic (MCKC)

Kidney Care Clinic Paper Referral Form

Non-invasive Vascular Ultrasound

Diagnostic Imaging - General Requisition Form (2022)

Nuclear Medicine

Diagnostic Imaging - General Requisition Form (2022)

Orthopaedic Surgery

Surgery - Ortho Hip-Knee RAC Program Referral Form
Rapid Access Clinic Referral Form
Surgery - Fracture Clinic Referral Form

Palliative Care

MGH Outpatient Palliative Care Clinic Referral Form (September 2023)

Prolonged-Ventilation Weaning Centre: For Healthcare Providers

Prolonged-Ventilation Weaning Centre - Referral Form
Long-Term Ventilation Program Placement Assessment Form

Provincial Prolonged-Ventilation Weaning Centre of Excellence and Long-term Ventilation

Prolonged-Ventilation Weaning Centre - Repatriation Letter
Prolonged-Ventilation Weaning Centre - Referral Form
Prolonged-Ventilation Weaning Centre - Transfer Checklist
Long-Term Ventilation Program Placement Assessment Form

Psychogeriatric Care

Mental Health & Addiction Services Referral Form

The Chest Centre (Respirology)

Sleep Lab referral form
The Chest Centre (Respirology) Referral Form
Time to Treat (Respirology) Referral Form

Thoracic Surgery

Surgery - Diagnostic Assessment Unit (DAU) - Chest - Referral Form

Ultrasound

Diagnostic Imaging - General Requisition Form (2022)

X-Ray (Radiography)

Diagnostic Imaging - General Requisition Form (2022)
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