Ottawa cancer referral form 2026

1. Click ‘Get Form’ to open the Ottawa Cancer Referral Form in our editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, date of birth, and any previous names. Select the sex and provide OHIP or other identification details.
3. Complete the address fields including city, province, and postal code. Ensure to include contact numbers for home, work, and cell.
4. Indicate if the patient has special needs or requires an interpreter by checking the appropriate boxes and specifying any necessary details.
5. In the 'Referral Information' section, select the cancer type from the options provided and indicate urgency if applicable. Provide comments as needed.
6. Fill out 'Clinical Information' with relevant dates and procedures. Specify if further surgery is planned and list any reports requested.
7. Finally, complete the 'Referring Physician' section with your printed name, signature, date, telephone number, and fax number before submitting.

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