Forms

Please select and download the appropriate form and send it using one of the following methods:

• Save this form and email to: contact@dr.ly
• Print this form and fax to: (306)-585-3993

[box][ilink url=”https://heart.ly/wp-content/uploads/2011/07/Request-for-Consultation1.pdf” style=”download”]Referral for Consultation[/ilink][/box]

[box][ilink url=”https://heart.ly/wp-content/uploads/2011/07/Request-for-Echo1.pdf” style=”download”]Referral for Echocardiogram[/ilink][/box]

[box][ilink url=”https://heart.ly/wp-content/uploads/2011/07/Request-for-Ambulatory-Holter-ECG1.pdf” style=”download”]Referral for Holter ECG[/ilink][/box]

[box][ilink url=”https://heart.ly/wp-content/uploads/2011/07/Request-for-Stress-Testing1.pdf” style=”download”]Referral for Stress-Test[/ilink][/box]

[box][ilink url=”https://heart.ly/wp-content/uploads/2011/07/Request-for-Radionuclide-Stress-Test1.pdf” style=”download”]Request for Radionuclide Stress Test[/ilink][/box]

[box][ilink url=”https://heart.ly/wp-content/uploads/2011/07/Request-for-Tilt-Table-Test1.pdf” style=”download”]Request for Tilt Table Test[/ilink][/box]