Instructions
Download and complete the referral form.
Submit the completed form to the Plastics or UHN Breast Reconstruction Program at 416 340 4403, or directly to the physician. The form will be reviewed to ensure that it is complete; if incomplete, the form will be returned to you.
Our office will provide you with information about the patient’s first appointment.
Urgent Referral Instructions
Write a letter of referral. State the reason and make note of urgency.
Include the latest dictated clinical note or summary of the patient’s relevant medical issue.
Please indicate clearly if patient has already had mastectomy and is seeking delayed breast reconstruction or immediate breast reconstruction with mastectomy.
Fax the complete referral to 416 340 4403. If you do not know which physician to refer your patient to, please address referral to the Plastics Team and the referral will be assigned to a surgeon based on availability. You must make direct contact with the appropriate physician to complete an urgent referral.
Please note: All referrals are considered urgent.