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Referral Forms

Below you will find direct links to downloadable referral forms. If you need this information in another format, please contact us. 

Please note: Diagnostic Imaging services are now using Ocean eReferral. Faxed referrals are accepted, however, faxed referals have a longer processing time than eReferral.


Cardiac Wellness Referral Form
Community Paramedic
CT Requisition
Diabetes Care Referral Form
Diagnostic Imaging Requisition
Echocardiography Requisition
Mammogram Requisition 
Musculoskeletal (MSK) Central Intake, Assessment and Management program 
Nuclear Medicine Requisition
Pulmonary Function testing (PFT)
TeleCheck Referral Form

Did you find the referral form you were looking for? If not you can contact us and we will do our best to help you.

We acknowledge that our hospital resides within the traditional territory and ancestral lands of the Tionontati, Attawandaron, Haudenosaunee, and Anishinaabe peoples.

We also acknowledge that various municipalities within the County of Dufferin reside within the treaty lands named under the Haldimand Deed of 1784 and two of the Williams Treaties of 1818: Treaty 18: the Nottawasaga Purchase, and Treaty 19: the Ajetance Treaty.

We also acknowledge the land which forms the Town of Caledon is also part of the traditional Territory of the Huron-Wendat and Haudenosaunee Peoples, and the Anishnabek of the Williams Treaties.

This land is part of the Treaty Lands and Territory of the Mississaugas of the Credit First Nation.

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