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 Information for Health Care Providers


On this page health care providers will find information on how to make a referral, as well as the necessary referral and requisition forms as well as useful links to external resources on genetics.

How to Make a Referral

If you are a referring doctor you may fax or mail a referral to:

Room 1A100
Trillium Health Partners - Credit Valley Hospital
2200 Eglinton Ave. W.
Mississauga, Ontario L5M 2N1
Fax: (905) 813-4347
Please send a referral note including the following information:

  • Patient's demographic information (full name, date of birth, address, phone number, health card number)
  • Referring physician's full name and phone number
  • Reason for referral
  • Relevant family history (i.e., who is affected, how are they related to your patient, age of diagnosis)
  • Medical records (i.e., test results, consultation letters, pathology reports) for patient or affected individuals
  • If your patient is pregnant, please indicate the date of her LMP on the referral form. Also, please fax the referral, along with her blood group, CBC and hemoglobin electrophoresis (if available).

If you are uncertain about a referral to Genetics, please contact our staff at (905) 813-4104 to review the details.

Requisitions & Forms

Referral to Clinical Genetics

Clinical Genetics Referral Form [pdf]
Familial Cancer Genetics Program Referral Form [pdf]
Cardiogenetics Program Referral Form [pdf]
Amniocentesis procedure referral form (#1002 D HR)
QF-PCR fact sheet


THP Cytogenetics Laboratory Requisition [pdf]
THP Molecular Diagnostic Laboratory Requisition [pdf]
THP Microarray Test Requisition [pdf]
For more information about Microarray Test see pdf brochure
Prenatal Screening Requisition [pdf]
For more information about eFTS see Changes to Prenatal Screening page
THP Molecular Oncology & Hematology Testing Requisition [pdf]
Prenatal Microarray Requisition [pdf]

Prenatal Genetics

NT ultrasound units

Hereditary Cancer Genetics

Testing Criteria HBOC panel 2020

Laboratory Licenses

For Laboratory Licenses and Accreditation Certificates, see this page.

Useful Links

Gene clinics:
Canadian Association of Genetic Counsellors: