Physician Portal

Patient Referral Forms

To download the referral form, please click on the relevant button below

Dr.Dolapo Oseji - Adult and Geriatric Psychiatry
Dr.Hesham Kaawan - Internal Medicine
Submission Workflow

How to Submit Patient Referrals

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Download & Complete Form

Attach Relevant Records

Send Fax

Fill out patient demographics, clinical history, current medications, and specific diagnostic questions. Form is also available on healthquest emr

Include recent lab investigations, diagnostic imaging reports, and relevant specialist clinical notes.

Submit completed files via fax to 587 557 9700

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hello@azuramedicalclinic.com

Phone : 587-557-9797

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