Lawrence Park Cardiology
 3080 Yonge Street Suite 4022
Toronto, Ontario M4N 3N1
PLEASE NOTE: Patients may request a follow up appointment only if they have been seen in the clinic in the last 24 months, otherwise, kindly obtain a new referral from your General Practitioner or Family Doctor prior to requesting an appointment.

If contact information is not provided, patient will not be contacted.

Please enable JavaScript in your browser to complete this form.
GENDER
SUNNYBROOK HOSPITAL DISCHARGE PATIENT
SUNNYBROOK GIM PATIENT
CLINICAL EVALUATION
TESTS REQUIRED
HOLTER MONITOR (Indicate one)
PROVIDERS

REFERRING PHYSICIAN

Click or drag a file to this area to upload.