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Home Holter Program

Online Referral

Step 1 of 5 - Please note: all referrals are sent via secure web portal and will be processed within 24 hours.

Please select one.(Required)

Urgent

Semi-Urgent

Routine

PATIENT INFORMATION

Name(Required)

First Last

Date of Birth(Required)

Month

Day

Year

Gender

Male

Female

Healthcard #(Required)

Version Code(Required)

Primary Phone #(Required)

Secondary Phone #

REFERRING PHYSICIAN INFORMATION

MD Name/Signature(Required)

First Last

MD Billing number(Required)

Date(Required)

MM slash DD slash YYYY

Phone(Required)

Fax

CARDIOVASCULAR DIAGNOSTICS

Patient Preferred Location

Windsor

Essex

Lasalle

WALK-IN SERVICES (8AM-4PM)

EKG / Electrocardiography

24 hr ABP monitor ($25 not covered by OHIP)

Holter:

Holter Pick-Up from Office

Mail Holter to Patient's Home

BY APPOINTMENT ONLY

Exercise Stress Echo with Consult

2D Echocardiogram +/- contrast / bubble study

Exercise Stress Echo Only (Consult, if deemed necessary by MD)

HOLTER TESTING DURATION

24-72 hr

7-14 day

INDICATION FOR DIAGNOSTICS AND/OR CONSULTATION

Chest Pain

Dyspnea

Edema

Palpitations

Pre/Syncope

Arrhythmias

Heart Murmur

HTN

CAD/MI

Cardiovascular Screening

Valvular Stenosis

Valvular Regurgitation

Prosthetic Heart Valve

Thoracic Aortic Disease

Congenital Heart Disease

Pulmonary Disease

Stroke/TIA

CHF

Other

You have selected Other - Please list

If diagnostic test is abnormal, please automatically arrange for Cardiology Consultation.

Yes

Notes

CARDIOLOGY CONSULTATION

Next Available

Dr. Roland Mikhail

Dr. Dhssraj Singh

Dr. Jeffrey Anchan

Dr. Brian Hachey

Dr. Nisar Huq

Name

This field is for validation purposes and should be left unchanged.

Contact Us

(519) 977-6643
(519) 915-6326
contact@windsorheart.org

Locations

Serving Windsor, Essex, LaSalle, Leamington, Lakeshore, and Kingsville.

Click Here for Details

Test Prep & Directions

You’ve been referred to the Windsor Heart Institute! Find out how you can prep for your test.

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Home
Diagnostic Testing
Cardiac Consultation
Physician Referrals
FAQs
Who We Are
- Our Team
- Newsletter
Contact
Home Holter Program