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Address: 250 8500 Blackfoot Trail SE
Calgary, Alberta T2J 7E1
Phone: 403.879.7911
Fax: 403.879.7899

Address: 201 3151 27st NE
Calgary, Alberta T1Y 0B4
Phone: 403.235.4109
Fax: 403.235.4147
Address: 250 8500 Blackfoot Trail SE Calgary, Alberta T2J 7E1
Phone: 403.879.7911
Fax: 403.879.7899
Address: 201 3151 27st NE Calgary, Alberta T1Y 0B4
Phone: 403.235.4109
Fax: 403.235.4147

    Patient Information

    Referring Physician

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    Urgency

    ASAPUrgent (within 2 weeks)Semi-Urgent (more than 2 weeks)1Phone Consult - Call 403.235.4109 to request

    Consult

    Consultation Requested

    CardiologyInternal MedicineEndocrinologyHeart Failure ClinicGeriatric Medicine

    Clinical Notes

    Please fax recent lab investigations, including Lipids, ECG and Medication list.

    Cardiac Diagnostic Examination

    Myocardial Perfusion Imaging (MPI)
    (includes Cardiology consult)

    Exercise MPIPharmacological MPI

    Does Your Patient Have:

    Patient Likehood of CAD:

    Medication:


    Indications
    Please check all that apply

    Abnormal ECGCAD / CHFPost PCIF/U known stable CADAbnormal Treadmill Stress TestMurmurChest painShortness of breathFunctional Significance Coronary StenosisPalpitations / Arrhythmias (suspected/known history of arrhythmias)Edema / PND / OrthopneaHypertension / Left ventricular hypertrophyPulmonary HypertensionCardiovascular risk assessment (suspected/known history of arrhythmias)Syncope / Presyncope / Vertigo / DizzinessStroke / TIACarotid bruitFollow-up of known carotid stenosisPost-surgical angiographic intervention follow-upReproductive MedicineDiabetesHypo / Hyper ThyroidHormone Health

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