The forms listed below are for Ophthalmologists to book Diagnostic Testing or/and Orthoptic Assessment within the Ivey Eye Institute at St. Joseph's Hospital.
- General/Cornea/Glaucoma Diagnostic requisition
- Retina Diagnostic requisition
- Lenstar and IOL Master Consent
- Intravenous Fluorescein Angiography Consent
- Request for Orthoptic Assessment
The above General/Cornea/Glaucoma Diagnostic requisition, Retina requisition, Lenstar and IOL Master Consent form and Intravenous Florescin Angiography Consent forms must be printed and filled in and then faxed to our Diagnostic Department at 519 646-6052.
The Orthoptic Assessment form must be faxed to 519 646-6056.
If you have any questions, regarding the use of these forms, please phone our reception desk at 519 646-6100 ext. 66018.