Referral to Diagnostic Imaging and Image Guided Therapy
Referring professional identifies Diagnostic Imaging exam needed.
Referring professional contacts the appropriate DI Modality directly if further information or instruction on the process is required.
Note: If a patient will need sedation or general anesthetic (GA) the referring professional must identify a responsible SickKids physician before booking the exam.
Referring professional prints and completes Request for Diagnostic Imaging or Request for Image Guided Therapy (IGT) form. If more than one DI Modality is needed please complete a separate Request for Diagnostic Imaging form for each DI Modality.
In addition, the following forms have to be completed if applicable:
- For MRI exam - MRI Screening Form
- For sedation or general anesthetic (GA) for any of the exams - DI Sedation/GA Screening Form
Note: For proper format, the browser "base" font size should be set to 12 point.
Referring professional faxes or mails the completed forms to the appropriate DI Modality.
Main floor - Atrium
|416-813-4960|| 416-813 -7644|
|GI-GU||2nd floor - Elm Wing||416-813 -6068||416-813 -6043|
|2nd floor - Black Wing||416-813 -6082||416-813 -1075|
|Nuclear Medicine||2nd floor - Elm Wing||416-813 -6065||416-813 -6043|
|CT||2nd floor - Elm Wing||416-813 -6070||416-813 -7683|
|Service Level Rm. S762||416-813 -5774||416-813 -5789|
The Hospital for Sick Children
555 University Ave.
Note: Please specify clinic name above the hospital address.
Upon receipt of the completed form(s), DI Modality provides referring physician, family and/or patient with appropriate information and/or instructions for appointment (via mail or telephone).