Diagnostic Requisitions - Physicians only
This page is designed to allow physicians electronic access to the most current Diagnostic Imaging requisitions.
These requisition forms are for physicians to complete only. They are not intended for patients to complete.
No Diagnostic Imaging exam will be performed at any QHC hospital without a fully completed requisition signed by a licensed physician. Any requisition that appears fraudlent will be investigated immediately and imaging services WILL NOT be provided.
- Breast Imaging Requisition
- Breast MRI requisition
- CT Requisition
- CT Colonography Requisition
- CT Cardiac requisition
- Interventional Radiology Consultation
- MRI Requisition
- MRI Requisition Peterborough Regional Health Centre (temporary for during QHC MRI downtime)
- Nuclear Cardiology Requisition
- Nuclear Medicine Requisition
- Radiology, BMD Requisition