Health Care Provider Forms

Diagnostic Services Forms

Diagnostic Services Forms

Diagnostic Imaging (ECG/EEG, ECHO, Mammography, MRI, Ultrasound & X-Ray) and Laboratory Services referral, requisitions and information forms.

Medical Clinic/Program Forms

Medical Clinic/Program Forms

Anticoagulation, Chemotherapy, Cystoscopy, Endoscopy, Kidney Care, Ophthalmology, Orhtopedic, Pacemaker, Pain Management, Pulmonary Function, Stroke Prevention, Women’s, Wound Clinics & Telemedicine services referral and information forms.

Mental Health & Addictions Forms

Mental Health & Addictions Forms

Mental Health and Addiction services (Regional Outreach & Seniors and Regional Specialized Program) referral and admission forms.

Other Forms

Other Forms

All other forms can be found in this section: Consent to Treatment, Clinic Fee Schedule, Bed Allocation Form, Dear Patient – Influenza & Faxing Order Form (Orders Faxed from Physician’s Offices).

Rehabilitation (Inpatient & Outpatient) Forms

Rehabilitation (Inpatient & Outpatient) Forms

Rehabilitation services (Occupational Therapy, Physiotherapy, Rehabilitation & Speech Language Pathology) referral forms and medical directives.

Surgical Services Forms

Surgical Services Forms

Surgical services questionnaires, referral, booking and information forms (Inpatient, Outpatient, Operating Room, PACU, Pre-Admission, Urodynamic & Vasectomy Clinics).

Women & Children Forms

Women & Children Forms

Birthing, Gynecology, Neonatal Intensive Care, Pediatrics, Respiratory Syncytial Virus and Social Services screening, information and pre-admission forms.

North Bay

50 College Drive,
P.O. Box 2500
North Bay, ON
P1B 5A4
Tel: 705-474-8600

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Sudbury

680 Kirkwood Drive,
Sudbury, ON
P3E 1X3
Tel: 705-675-9193
Fax: 705-675-6817

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Floor Plans

Let us guide you to where you need to go.

Visitors Guide

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