Online Referral - Good Health Cardiac Clinics

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Guelph: goodhealthcps@goodclinic.ca
Markham: goodhealthmarkham@goodclinic.ca

Guelph: 226-807-6600
Markham: 289-505-9134

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- Guelph
- Markham
Online Referral
- Guelph
- Markham

Home
About Us
- Our Story
- Meet the Team
Services
For Patients
For Clinicians
Contact Us
- Guelph
- Markham
Online Referral
- Guelph
- Markham

Online Referral - Guelph

PATIENT INFORMATION:

First Name

Last Name

DOB

Health Card Number

VC

Phone

Email

Gender

Female Male

REFERRING PHYSICIAN:

Clinic Name

Billing #:

Physician Name

Physician Signature

Date

Level of Urgency

Urgent Semi-Urgent Elective

Consultation

Consultation Consult If Test Result Is Positive/ Abnormal

Diagnostics

Echocardiogram

Holter Monitoring

24 hr 48 hr 72 hr 14 Day

Ambulatory Blood Pressure Monitor

24 hr ($75 fee not covered by OHIP)

Stress Testing

Treadmill Stress Test with Consultation Exercise Stress Echocardiogram with Consultation

INDICATION: Check all that apply

Chest Pain Dyspnea High Risk CV Profile Atrial Fibrillation Presyncope / Syncope Cardiac Source of Embolism Murmur Palpitations Bradycardia Heart Failure Cardiomyopathy Dyslipidemia

Please provide all relevant clinical information

We are a specialized group that collaborates with cardiologists across Ontario to build and operate state-of-the-art cardiac diagnostic clinics.

Contact Info

Good Health CPS Guelph Cardiac Clinic

350 Eramosa Road, Guelph, ON, Canada
226-807-6600
226-770-5338
goodhealthcps@goodclinic.ca

Good Health Markham Cardiac Clinic

8500 Leslie Street, Suite 100 Markham, ON L3T 7M8
289-505-9134
905-581-6352
goodhealthmarkham@goodclinic.ca

Operating Hours

Mon 8:00 AM - 5:00 PM

Tue 8:00 AM - 5:00 PM

Wed 8:00 AM - 5:00 PM

Thu 8:00 AM - 5:00 PM

Fri 8:00 AM - 5:00 PM

Sat Closed

Sun Closed

We are a specialized group that collaborates with cardiologists across Ontario to build and operate state-of-the-art cardiac diagnostic clinics.

Contact Info

350 Eramosa Road, Guelph, ON, Canada
226-807-6600
226-770-5338
goodhealthcps@goodclinic.ca

Operating Hours

Monday 8:00 AM - 5:00 PM

Tuesday 8:00 AM - 5:00 PM

Wednesday 8:00 AM - 5:00 PM

Thursday 8:00 AM - 5:00 PM

Friday 8:00 AM - 5:00 PM

Saturday Closed

Sunday Closed

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