How to Make A Referral

We accept referrals from physicians or other healthcare providers. Self referrals are not accepted.

  1. Please have your healthcare provider fax or mail a referral to:

    Room 2G500
    The Credit Valley Hospital
    2200 Eglinton Avenue West
    Mississauga, ON
    L5M 2N1

  2. Fax: (905) 813-4347

Please send a referral note including the information listed below. If you wish, a PDF of our referral form can be downloaded from our protected requisition area:
Physician Referral Form #6302 [pdf] »

Important information to include in the referral:

  • Patient’s demographic information (full name, date of birth, address, phone number, health card number)
  • Referring physician’s full name and phone number
  • Reason for referral
  • Relevant family history (ie. who is affected, how are they related to your patient, age of diagnosis)
  • Medical records (ie. test results, consultation letters, pathology reports) for patient or affected individuals
  1. NOTE:

    As of March 1, 2010, Clinical Genetics at The Credit Valley Hospital will no longer be accepting prenatal referrals for advanced maternal age counseling without any genetic risk factors.

    For further information, please refer to Advanced Maternal Age Referral Memo[pdf]»

If your patient is pregnant, please indicate the date of her LMP on the referral form. Also, please fax the referral, along with her blood group, CBC and hemoglobin electrophoresis (if available).

If you are uncertain about a referral to Genetics, please contact our staff at (905) 813-4104 to review the details.


CVH referral form

form download

This form is for one-time print and use only. Do not photocopy. Copies will become outdated - referring patients via an outdated form will result in processing delays.
Always use recently downloaded and printed form.
Requisition form must be signed by a referring physician.

By clicking here you agree to above terms and conditions: [download pdf form]

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