Patient Requisition Forms
Online Requisition Form
Easily fill out our hassle-free online form to refer your patient to a cardiologist.
Printable Requisition Form
Have your physician complete the fillable PDF, then upload or email it to us.
The hMD Approach
Private & secure
“Trust is the cornerstone of our relationships.”
We are committed to safeguarding your personal and medical information at every step. Our systems and processes are designed to meet the highest privacy standards, so you can feel confident using our services.
HIPAA-Compliant Practices
“We strive to keep your data protected.”
We strictly adhere to HIPAA guidelines, ensuring all patient data is stored, accessed, and shared only through secure and compliant systems.
Confidential Communications
“Your conversations with us stay between us.”
Test results are shared through secure channels and only with authorized providers, keeping your cardiac health information private and professionally managed.
Ready to Submit a Referral?
Fill out the online referral form or upload the completed PDF to share your patient’s details with our team.
Here’s what makes us different from conventional clinics.
At Heart Map Diagnostics, we are passionate about improving lives through knowledge and empowerment.
24+ years experience
Trusted by healthcare professionals for over two decades of cardiac care.
Fast process, best result
Efficient workflows that deliver accurate results quickly every time.
Professional medical team
Expert cardiologists dedicated to collaborative and personalized patient care.
FAQ
Frequently Asked Questions!
Still have questions about booking? Your health is our priority, and we’re here to support you every step of the way.
Have any Questions?
We’re here to help. Reach out anytime with your questions or feedback.
How do I book a consultation?
Simply fill out the appointment request form. Choose your preferred date and time, and our team will follow up by phone or email to confirm your visit. If you have a specific test in mind, mention it in the message section so we can prepare accordingly.
Do I need a referral to book?
Yes, all cardiac diagnostic tests require a referral from your physician. Your doctor will provide the necessary medical information for our cardiologist to conduct a thorough assessment and recommend appropriate testing.
What happens after I submit the form?
Once you submit the appointment request form, our team will contact you within 1-2 business days to confirm your appointment details. We’ll discuss your specific needs and provide any necessary preparation instructions for your scheduled test.
Can I reschedule my appointment later?
Yes, you can reschedule your appointment by contacting us at least 24 hours in advance. Call us at 437-523-4343 or email us, and we’ll help you find a new time that works for your schedule.
Are your services covered by OHIP?
Most of our cardiac diagnostic services are covered by OHIP, including ECG, echocardiography, stress tests, and Holter monitoring. However, Ambulatory Blood Pressure Monitoring (ABPM) is not covered by OHIP and requires a fee of $70. Please check with our team if you have questions about specific test coverage.