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St. Michael's Vascular Surgery Clinic referral form 2026

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The document is a referral form for St Michael’s Vascular Surgery Clinic, detailing the process for both elective and urgent consultations. It includes contact information, a list of medical professionals, patient information fields, clinical history indications related to vascular issues, and sections for the referring physician's details.

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Click ‘Get Form’ to open the St. Michael's Vascular Surgery Clinic referral form in the editor.
Begin by selecting the type of consultation needed: either 'Elective Consultation' or 'Urgent Consultation' by checking the appropriate box.
Fill in the date at the top of the form to indicate when the referral is being made.
In the 'Patient Information' section, enter the patient's name, phone number, date of birth (DOB), and OHIP number accurately.
Provide the patient's address in the designated field to ensure proper communication.
Detail any clinical history or symptoms in the 'Clinical History' section by checking relevant indications such as Carotid Bruit or Diabetic Foot.
Complete the 'Referring Physician' section with your name, phone number, signature, billing number, and fax number for verification purposes.

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What happens at a vascular appointment?

You should wear comfortable clothing that is easy to change out of, since you may need to change into a gown. After discussing your history, the vascular surgeon will perform an exam in any areas where youre having problems. They will diagnose your condition and recommend an appropriate treatment plan.

Why would you be referred to a vascular doctor?

When to see a vascular doctor. You might need to see a vascular doctor if youre at high risk of vascular disease because of your diabetes, high blood pressure and use of tobacco products. Also, you might have symptoms of a vascular disease, such as chest pain during exercise or leg pain, cramping or swelling.

How do I prepare for a vascular appointment?

Be prepared to carefully describe any symptoms that you believe may be referable to vascular disease. Tell the vascular surgeon how long symptoms have been present, when and where they occur, and how severe they seem. Take a list of medications and existing diseases under treatment. Take recent blood test results.

vascular surgery referral

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