Referring a Patient
Our SRCC team at Southlake is committed to ensuring your patients receive consistently high quality cancer care in a timely manner, and as close to their home as possible. We also aim to follow-up with referring physicians and health care professionals, as quickly as possible.
To refer a patient to the SRCC at Southlake (for the Central Regional Cancer Program) for cancer treatment, psychosocial oncology, palliative care, radiation oncology or Diagnostic Assessment Unit (DAU), download, complete and fax the appropriate Referral Form from the list below to 905-952-2820.
Central Regional Cancer Program:
Diagnostic Assessment Unit (DAU):
- Diagnostic Assessment Unit Breast Clinic Physician Referral (SL0806)
- Colon Cancer Check Referral Form (SL 1367A) (Use this form to refer patients to the Diagnostic Assessment Unit for colonoscopy in cases where there has been a positive FOBT or first-degree relative with history of colon cancer.)
- Lung Diagnostic Assessment Program Referral Form (SL1697)
- Prostate Assessment Clinic Physician Referral Form (SL1568)
- Skin Cancer Diagnostic Assessment – Physician Referral (SL2129_01)
Avoid Delays: Provide All Requirements
To ensure your patient is seen as quickly as possible, it is the referring physician’s responsibility to ensure form is complete and accurate before submission.
Before faxing your referral, ensure you include all of following applicable items:
- Completed New Patient Referral Form
- Contact number and alternate contact number
- Diagnosis or clinical reason for referral
- X-ray, U/S, CT, MRI, PET scan, Mammogram, Bone scan report(s)
- Date/place of scheduled diagnostic bookings
- Most recent consult note
- Recent Lab reports
- Recent Pathology or previous pathology
- Operative report
Unfortunately, an incomplete submission will delay your referral. We return incomplete submissions to the referring physician with this Incomplete Information form.
Our team is committed to ensuring your patients receive consistently high quality cancer care in a timely manner, and as close to their home as possible. We also aim to follow-up with referring physicians and health care professionals as quickly as possible.
Preparing Patients for Treatment
When you refer a patient, you can also help them prepare for treatment by sending them to website of the cancer centre where you refer them:
- If you refer them to the SRCC at Southlake, send them to the Patient & Caregiver section of this site and the New Patient Information Guide to learn more OR
- Refer them to the cancer section of the relevant hospital partner
If your patient smokes, check this video to learn what you can do to encourage them to quit smoking.