Requisition Forms

Download Requisition Form

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CT/MRI Requisition Form
(Ajax/Mississauga locations)

You are able to complete this form on your computer, however, please print out and fax it to your desired location:

  • Kitchener / Waterloo
    519–576–8768
  • Thornhill and North York
    416–223–8335
  • Women’s Clinic 790 Bay #716
    416-260-1687
  • General Clinic 790 Bay #716
    416.-260-2274
  • The Path 11 King St.
    416-864-1499
  • Pickering
    905-420-6057
  • Newmarket
    905-836-5043