Vascular Services Referrals Form

Shared on behalf of Wayne Taylor, Director, Cardiovascular, Medicine & Renal Program Regional Director, NW Regional Renal Program, Ontario Renal Network and Caroline Fanti, Director Regional Surgical Services


As of May 21st, 2025, ALL referrals for vascular assessment will now be received via the Cardiovascular Central Intake to be triaged to the RAVE clinic or the North of Superior Vascular Surgery offices (excluding dialysis access-related, which continue to be managed via the Renal Department at TBRHSC).

Please see the attached NEW Vascular Services Referral Form (FCS-490) available via the TBRHSC Print Shop. This form REPLACES the former RAVE Clinic referral form (CS-1077). The form is available from the TBRHSC Print Shop at no charge via TBRHSC.PrintShop@tbh.net.

Please remove the discontinued RAVE Clinic form from circulation in your office(s).

As always, referrals can be sent via fax to the Central Intake at 807-684-9561.

Additionally, referrals can also be completed via the OCEAN platform through the TBRHSC Cardiovascular Services Intake OR via the TBRHSC Surgical Services Intake.

As a reminder, a complete Vascular Services referral must include:

  • Completed Vascular Services Referral Form
  • A note including medical history
  • A current medication list
  • Relevant diagnostic imaging if NOT available via Sectra PACS at TBRHSC

Please also see attached Frequently Asked Questions for reference and do not hesitate to contact the
Coordinator of Cardiovascular Services at (807)-684-6206 with any questions or concerns.