Diagnostic Assessment Program Referral Forms
Notice: This page is no longer being updated.
Only selected forms are linked here and those links may be out of date. They will be removed at the the end of January 2026.
For all disease sites and locations listed, please contact the relevant regional cancer program directly for their most current referral forms and information.
| REGIONAL CANCER PROGRAM | FACILITY | REFERRAL FORMS (links available until January 2026) |
REGIONAL CANCER CENTRE CONTACT INFORMATION |
| South West | Brightshores Health - Owen Sound |
Skin |
Phone: 519-685-8600 Website: Verspeeten Family Cancer Centre |
| South West | London Health Sciences |
Hepato/Pancreatic/Biliary (HPB) Oncology Patient Navigation Program forms: Esophageal GU/Bladder Head & Neck Intraperitoneal (listed as peritoneal) Sarcoma |
Phone: 519-685-8600 Website: Verspeeten Family Cancer Centre |
| South West | St. Joseph’s Health Care London |
Breast |
Phone: 519-685-8600 Website: Verspeeten Family Cancer Centre |
| Waterloo Wellington | Waterloo Wellington Regional Cancer Centre | Lung | Email: wwregionalcancerprogram@grhosp.on.ca Website: Waterloo Wellington Regional Cancer Program |
| Hamilton Niagara Haldimand Brant | St. Joseph's Healthcare Hamilton | Lung, Esophageal |
Phone: 905-521-2100 ext. 79280 Website: Hamilton Niagara Haldimand Brant Regional Cancer Program |
| Hamilton Niagara Haldimand Brant | Brant Community Health System General – Joseph Brant Hospital |
Breast Colorectal Lung |
Phone: 905-521-2100 ext. 79280 Website: Hamilton Niagara Haldimand Brant Regional Cancer Program |
| Hamilton Niagara Haldimand Brant | Niagara Health – St. Catharine's |
Lung Prostate |
Phone: 905-521-2100 ext. 79280 Website: Hamilton Niagara Haldimand Brant Regional Cancer Program |
| Mississauga Halton/Central West |
Trillium Health Partners Mississauga Halton/Central West Regional Cancer Program |
Colorectal (OTMH) Hepato-Pancreatic-Biliary (HPB) Lung (OTMH) |
Email: mhcwrcp@thp.ca Website: The Mississauga Halton Central West Regional Cancer Program |
| Mississauga Halton/Central West | William Osler Health System |
Breast (BCH) Breast (EGH) Colorectal Thoracic (BCH) |
Email: mhcwrcp@thp.ca Website: The Mississauga Halton Central West Regional Cancer Program |
| Toronto Central (South) | Mount Sinai Hospital | Colorectal | Phone: 416-596-4200 Website: Mount Sinai Hospital |
| Toronto Central (South) | St. Michael's Hospital | Colorectal | Phone: 416-360-4000 Website: St. Michael’s Hospital |
| Toronto Central (South) | University Health Network |
Pancreatic |
Princess Margaret Cancer Centre Odette Cancer Centre |
| Toronto Central (North) | Sunnybrook Health Sciences Centre |
Anal Breast |
Princess Margaret Cancer Centre Odette Cancer Centre |
| Toronto Central (North) | Michael Garron Hospital |
Princess Margaret Cancer Centre Odette Cancer Centre |
|
| Central |
Humber River Health Mackenzie Richmond Hill Hospital Oak Valley Health - Markham Stouffville |
Breast | Phone: 905-830-5800 Website: Southlake Health |
| Central | North York General Hospital |
Breast Colorectal |
Phone: 905-830-5800 Website: Southlake Health |
| Central | Southlake Regional Health Centre |
Esophageal |
Phone: 905-830-5800 Website: Southlake Health |
| Central East | Lakeridge Health Oshawa |
|
Phone: 905-576-8711 Website: Lakeridge Health |
| Central East |
Lakeridge Health Oshawa Northumberland Hills Hospital Peterborough Regional Health Centre |
Thoracic | Phone: 905-576-8711 Website: Lakeridge Health |
| South East | Kingston General Hospital |
Breast Esophageal/Gastric Suspicion of Cancer (SOC) |
Phone: 613-549-6666 Website: Kingston Health Sciences Centre |
| South East | Hotel Dieu, Kingston | Colorectal | Phone: 613-549-6666 Website: Kingston Health Sciences Centre |
| Champlain |
The Ottawa Hospital Cancer Assessment Clinic Ottawa Regional Women's Breast Health Centre |
Breast, Lung, Colorectal, Prostate Gynecology Hepato-Pancreatic-Biliary (HPB) Thoracic |
Phone: 613-737-7700 Website: The Ottawa Hospital Cancer Centre |
| North Simcoe Muskoka | Royal Victoria Hospital |
Breast Gynecology Rectal Skin Suspicion of Cancer (SOC) Thoracic |
Phone: 705-728-9090 ext. 43333 |
| North East |
Health Sciences North North East Cancer Centre |
Phone: 705-522-6237 Website: Shirley & Jim Fielding Northeast Cancer Centre |
|
| North West | Thunder Bay Regional Health Sciences Centre |
Colorectal |
Phone: 807-684-6000 Website: Regional Cancer Care Northwest |