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CME Talks
Student Placement
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Associated Clinics
Yorkview Cardiology
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Dietitian
Physicians
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Contact Us
About
Our Clinic
CME Talks
Student Placement
Testimonials
Associated Clinics
Yorkview Cardiology
Covid-19
Our Team
Services
Cardiology Services
Dietitian
Physicians
Send Referral
Downloadable Referral
Patients
Make Appointment
Submit Testimonial
News
About
Our Clinic
CME Talks
Student Placement
Testimonials
Associated Clinics
Yorkview Cardiology
Covid-19
Our Team
Services
Cardiology Services
Dietitian
Physicians
Send Referral
Downloadable Referral
Patients
Make Appointment
Submit Testimonial
News
3080 Yonge Street Suite 4022
Toronto, Ontario M4N 3N1
647-347-6644
admin@lpcardiology.com
PATIENT NAME
ADDRESS
DATE OF BIRTH
GENDER
F
M
HEALTH CARD NUMBER
VERSION CODE
EMAIL ADDRESS
HOME PHONE NUMBER
CELL PHONE NUMBER
CLINICAL EVALUATION
Consultation
Consult, if abnormal
Neuro-Vascular, Stroke, TIA Clinic
Hypertension & Diabetes
Internal Medicine & Geriatrics
TESTS REQUIRED
Echocardiogram
Stress Echo
Treadmill Stress Test
12 Lead ECG
24 HR ABP Monitor (not covered by OHIP)
HOLTER MONITOR (Indicate one)
24hr
48hr
72hr
96hr
7 days
14 days
14 Loop event recorder (not covered by OHIP)
REASON FOR VISIT
PROVIDERS
First Available
Dr. Eugene Crystal MD, FRCPC
Dr. Ilan Lashevsky MD, FRCPC
Dr. Alex Crystal MD, FRCPC
Dr. Cam Joyner MD, FRCPC
Dr. Mina Madan MD, FRCPC
Dr. Ashish Patel MD, FRCPC
Dr. Tasnim Vira MD, FRCPC
Dr. Romana Dragojevic MD, Internal Med. & Hypertension
Dr. Houman Khosravani MD, Stroke &TIA
Dr. Christopher Lewis MD, Internal Med. & Geriatrics
Dietitian-Niloufar Deilami, RD MPH
REFERRING PHYSICIAN
PHYSICIAN NAME
PHYSICIAN NUMBER
PHYSICIAN FAX
PHYSICIAN EMAIL
Submit
