Patient Information: Forms for Ophthalmologists

The forms listed below are for Ophthalmologists to book Diagnostic Testing within the Ivey Eye Institute at St. Joseph's Hospital. Once a copy has been printed and filled in, it can be faxed to our Diagnostic Department at the following numbers:

St. Joseph's - Forms Fax: 646-6248

If you have any questions, regarding the use of these forms, please contact our Reception Desk at St. Joseph's at 646-6018.

All forms are in PDF format.

General/Cornea/Glaucoma Diagnostic requisition

Retina Diagnostic requisition

IOL Master Testing Consent

Intravenous Fluorescein Angiography Consent

Request for Orthoptic Assessment