Medical Imaging Referrals

Please see our referral criteria to make a referral to Medical Imaging.

The Joint Department of Medical Imaging is now accepting referrals through Ocean eReferral.

To refer a patient by fax, please use the appropriate form below. Please be sure to include:

All required patient demographics (including current phone number and mailing address)
All required ordering physician information, including a signature
The type of imaging required
Clinical information and area to be scanned (Including any relevant clinical notes or reports)
The clinical urgency and/or specified date of procedure (SDP)

Physicians that need to speak to a radiologist regarding escalation, please contact the JDMI call centre at 416-946-2809.

Referral details

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General requisition form (not MRI or CT)

Please complete this referral form (PDF) and fax it to the relevant modality.

CT request form

Please complete this referral form (PDF) and fax it to 416-586-3180.

CEOU requisition form

Please complete this referral form (PDF) and fax it to 416-586-8405.

MRI request form

Please complete this referral form (PDF) and fax it to 416-586-4797.

OBSP screening mammograms

Patients with no history or symptoms of breast cancer who are between 50 and 75 years of age can self-refer for screening mammograms. Phone the Marvell Koffler Breast Centre at the number below to book an appointment.

Mammogram appointments: 416-586-4800 ext. 4422

OBSP High Risk Screening Program

Referrals are accepted from health-care providers.

Patients can get screened through the OBSP High Risk Screening Program if they are aged 30 to 69, referred by a physician, have a valid Ontario Health Insurance Plan (OHIP) number, have any acute breast symptoms and fall into one of the following risk categories.

Patients are in a higher risk category if they have:

A gene mutation that increases their risk for breast cancer (for example, BRCA1, BRCA2, TP53, PTEN, CDH1)
A first-degree relative of someone with a gene mutation that increases their risk for breast cancer and have either had genetic counselling or decided not to have genetic testing
Been assessed by a genetics clinic as having a 25 per cent or higher lifetime risk of breast cancer based on personal and family
A history of chest radiation therapy for another cancer or condition (like Hodgkin Lymphoma) before age 30 at least eight years ago

To refer a patient, please complete this referral form (PDF) and fax it to 416-586-4714.