OneCare Cardiology

Upload a Patient Referral

Referral details and secure file upload information for patients and referrers.

Use this form to send a patient referral and supporting document to OneCare Cardiology. Do not use this form for emergencies.

Referrer name

Please provide referrer name.

Practice name

Please provide practice name.

Provider number

Please provide provider number.

Referrer phone

Please provide referrer phone.

Referrer email

Please provide referrer email.

Patient full name

Please provide patient full name.

Patient date of birth

Please provide patient date of birth.

Patient phone

Please provide patient phone.

Patient email

Please provide patient email.

Patient address

Please provide patient address.

Requested service

Please select a service.

Urgency

Please select urgency.

Reason for referral

Please provide the clinical reason.

Clinical notes

Referral file

PDF, JPG, JPEG or PNG. Maximum 10 MB.

I consent to the clinic using this information to process the referral.

Consent is required.

Appointments

Ready to take the next step?

Request a cardiology appointment or upload your referral for the clinic team to review. Urgent referrals should be discussed with the clinic directly.

Request an Appointment Upload Referral